Electronic Health Record-Integrated Clinical Decision Support for Clinicians Serving Populations Facing Health Care Disparities: Literature Review

International Journal of Engineering Pedagogy

article

Carole H. Stipelman¹  Polina V. Kukhareva³  Elly Trepman⁴  Quang-Tuyen Nguyen¹  Lourdes Valdez³  Colleen Kenost³  Maia Hightower²  Kensaku Kawamoto³ 

[1] Department of Pediatrics, University of Utah School of Medicine;Health Informatics, University of Utah School of Medicine;Department of Biomedical Informatics, University of Utah School of Medicine;Department of Medical Microbiology and Infectious Diseases, University of Manitoba;University of South Alabama College of Medicine;Department of Internal Medicine, University of Utah School of Medicine

关键词: Equity;    screening;    vulnerable populations;    medically underserved;    safety net;   

DOI  :  10.1055/s-0042-1742518

来源: International Society for Engineering Education (IGIP), Kassel University Press

【 摘 要 】

Objectives: To review current studies about designing andimplementing clinician-facing clinical decision support (CDS)integrated or interoperable with an electronic health record (EHR)to improve health care for populations facing disparities.Methods: We searched PubMed to identify studies publishedbetween January 1, 2011 and October 22, 2021 aboutclinician-facing CDS integrated or interoperable with an EHR.We screened abstracts and titles and extracted study data fromarticles using a protocol developed by team consensus. Extracteddata included patient population characteristics, clinical specialty,setting, EHR, clinical problem, CDS type, reported user-centereddesign, implementation strategies, and outcomes.Results: There were 28 studies (36 articles) included. Moststudies were performed at safety net institutions (14 studies)or Indian Health Service sites (6 studies). CDS tools wereimplemented in primary care outpatient settings in 24 studies(86%) for screening or treatment. CDS included point-of-carealerts (93%), order facilitators (46%), workflow support (39%),relevant information display (36%), expert systems (11%),and medication dosing support (7%). Successful outcomes werereported in 19 of 26 studies that reported outcomes (73%).User-centered design was reported during CDS planning (39%),development (32%), and implementation phase (25%). Mostfrequent implementation strategies were education (89%) andconsensus facilitation (50%). Conclusions: CDS tools may improve health equity and outcomesfor patients who face disparities. The present review underscoresthe need for high-quality analyses of CDS-associated healthoutcomes, reporting of user-centered design and implementationstrategies used in low-resource settings, and methods to disseminate CDS created to improve health equity.

【 授权许可】

Unknown