Use of Electronic Health Records to Develop and Implement a Silent Best Practice Alert Notification System for Patient Recruitment in Clinical Research: Quality Improvement Initiative

Devoe, Connor; Gabbidon, Harriett; Schussler, Nina; Cortese, Lauren; Caplan, Emily; Gorman, Colin; Jethwani, Kamal; Kvedar, Joseph C.; Agboola, Stephen

doi:10.2196/10020

Cited by 13 publications

(14 citation statements)

References 12 publications

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“…The following studies looked at using EHR in research (n=14)[9, 16, 27, 40-50] and development (n= 15). [20, 28, 31, 38, 40-43, 45, 47-52] Several studies looking at EHR in research showed its vast capabilities and positive implications.…”

Section: Resultsmentioning

confidence: 99%

Which electronic health record system should we use? – a systematic review

Ani

Garas

Hollingshead

et al. 2020

Preprint

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Objectives: This is the first systematic review to look at all published data on EHRs to determine which systems are advantageous. Design: A systematic review was performed by searching EMBASE and Ovid MEDLINE between 1974 and November 2019. Participants: All original studies that appraised EHR systems were included. Main outcome measures: EHR system comparison, implementation, user satisfaction, efficiency and performance, documentation, and research and development. Results: The search strategy identified 701 studies, which were filtered down to 46 relevant studies. Level of evidence ranged from 1 to 4 according to the Oxford Centre for Evidence-based Medicine. The majority of the studies were performed in the USA (n = 44). N=6 studies compared more than one EHR, and Epic followed by Cerner were the most favourable through direct comparison. N=17 studies evaluated implementation which highlighted that it was challenging, and productivity dipped in the early phase. N=5 studies reflected on user satisfaction, with women demonstrating higher satisfaction than men. Efficiency and performance issues were the driving force behind user dissatisfaction. N=26 studies addressed efficiency and performance, which improved with long-term use and familiarity. N=18 studies considered documentation and showed that EHRs had a positive impact with basic and speciality tasks. N=29 studies assessed research and development which revealed vast capabilities and positive implications. Conclusion: Epic is the most studied EHR system and the most commonly used vendor on the market. There is limited comparative data between EHR vendors, so it is difficult to assess which is the most advantageous system.

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Section: Resultsmentioning

confidence: 99%

Which electronic health record system should we use? – a systematic review

Ani

Garas

Hollingshead

et al. 2020

Preprint

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“…Best practice alerts (BPAs) are a growing tool that have been shown to improve health outcomes and reduce costs for multiple diseases and patient populations (Swedlund et al 2019 ; Bejjanki et al 2018 ). Implementing best practice alerts may help healthcare providers appropriately screen and place consults for our HVIP or even allow for automation of the referral process (Devoe et al 2019 ). Now that we have standard criteria for identifying eligible patients, we can use it to screen for youth who present to our EDTC with violent injuries as we develop a BPA.…”

Section: Discussionmentioning

confidence: 99%

Assessing improvements in emergency department referrals to a hospital-based violence intervention program

et al. 2021

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Background Youth violence is a major public health concern in the United States. Hospital-based Violence Intervention Programs (HVIPs) are integral in connecting youth sustaining interpersonal violence-related injuries to medical, mental health, and social services. At our pediatric emergency department, our baseline referral rate to the established HVIP was 32.5%. From November 2018–2019, we aimed to increase the percent of eligible patients referred to our HVIP from 32.5 to 70% for patients aged 7–18 years who present to our Level 1 emergency department/trauma center with a violent injury. Methods For this quality improvement project, we recorded key aspects of the referral process, such as patient eligibility, who placed referrals, and when referrals were placed in relation to the ED admission. Key stakeholders were interviewed to identify specific interventions. Our key interventions were: 1. Educating providers on eligibility requirements. 2. Encouraging nurses to enter consults at the time of admission. 3. Publishing information about program referrals in the weekly nursing newsletter. 4. Updating social workers on eligibility requirements for the HVIP. We used PDSA cycles to inform our project. Our primary outcome measure was the number of eligible patients referred to our HVIP and measures were analyzed using statistical process control charts. Results The HVIP-eligible population had the following demographics: 31.1% female and a mean age 14.3 ± 2.7, 82.6% assaults and 17.4% gunshot wounds. From 11/2018 to 11/2019, there were 78 referrals to the HVIP, out of 167 eligible patients. The referral rate improved from 32.5% pre-interventions to 61.1% post-interventions, showing an 88% increase. Conclusion(s) We noted an increase in referrals to our HVIP following our interventions that centered on educating, advertising, and encouraging. Future studies will focus on analyzing other aspects of the enrollment process, such as obtaining patient consent.

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“…[4][5][6][7] EHRbased clinical trial alerts (CTAs), which notify clinical personnel when a patient's EHR data meet presumptive criteria for enrollment in a clinical trial, have been utilized for many years. [8][9][10] CTAs are associated with higher recruitment yield and have improved cost-efficiency of clinical trials by reducing the time research staff spend on patient identification and screening. [11][12][13] EHR-based CTAs may be delivered to various recipients by various methods and can be used in combination with other recruitment strategies.…”

Section: Background and Significancementioning

confidence: 99%

Shared-Task Worklists Improve Clinical Trial Recruitment Workflow in an Academic Emergency Department

2021

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Background Clinical trials performed in our emergency department at Barnes-Jewish Hospital utilize a centralized infrastructure for alerting, screening, and enrollment with rule-based alerts sent to clinical research coordinators. Previously, all alerts were delivered as text messages via dedicated cellular phones. As the number of ongoing clinical trials increased, the volume of alerts grew to an unmanageable level. Therefore, we have changed our primary notification delivery method to study-specific, shared-task worklists integrated with our pre-existing web-based screening documentation system. Objective To evaluate the effects on screening and recruitment workflow of replacing text-message delivery of clinical trial alerts with study-specific shared-task worklists in a high-volume academic emergency department supporting multiple concurrent clinical trials. Methods We analyzed retrospective data on alerting, screening, and enrollment for 10 active clinical trials pre- and postimplementation of shared-task worklists. Results Notifications signaling the presence of potentially eligible subjects for clinical trials were more likely to result in a screen (p < 0.001) with the implementation of shared-task worklists compared with notifications delivered as text messages for 8/10 clinical trials. The change in workflow did not alter the likelihood of a notification resulting in an enrollment (p = 0.473). The Director of Research reported a substantial reduction in the amount of time spent redirecting clinical research coordinator screening activities. Conclusion Shared-task worklists, with the functionalities we have described, offer a viable alternative to delivery of clinical trial alerts via text message directly to clinical research coordinators recruiting for multiple concurrent clinical trials in a high-volume academic emergency department.

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Use of Electronic Health Records to Develop and Implement a Silent Best Practice Alert Notification System for Patient Recruitment in Clinical Research: Quality Improvement Initiative

Cited by 13 publications

References 12 publications

Which electronic health record system should we use? – a systematic review

Which electronic health record system should we use? – a systematic review

Assessing improvements in emergency department referrals to a hospital-based violence intervention program

Shared-Task Worklists Improve Clinical Trial Recruitment Workflow in an Academic Emergency Department

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