Richesson’s Research Study Can Close Gap in Electronic Health Record Application

Richesson’s Research Study Can Close Gap in Electronic Health Record Application

The combination of a growing number of patients with multiple chronic conditions and the enormous volume of medical knowledge in a electronic health record (EHR) is a challenge for clinicians to manage. Rachel Richesson, PhD, MS, MPH, FACMI, associate professor for Duke University School of Nursing (DUSON) and noted informaticist, was awarded the National Institutes of Health R15/ National Library of Medicine Award for her project entitled “Quantifying System and Data Readiness for Automated Clinical Decision Support (CDS).” The research would identify practice gaps to ensure that CDS intervention fits well in current workflows. The award of more than $400,000 is for a two-year period ending August 2018.

“Clinical decision support tools such as provider alerts and reminders or context on relevant treatment information, especially ones embedded in electronic health records, are important for clinicians treating patients with multiple chronic conditions,” Richesson said. “However, adopting CDS tools have been limited and studies show that a high proportion of CDS support alerts are often over-ridden by providers because it isn’t relevant or the timeliness of the alerts.”

Richesson’s research will support the proper placement of CDS tools and alerts with electronic health record system interfaces. Specifically, the project will examine the data features of the Duke University Health System EHR system relative to the data requirements for CDS interventions derived from a set of Choosing Wisely® evidence-based practice recommendations.  Choosing Wisely® is an initiative of the American Board of Internal Medicine (ABIM) Foundation that promotes patient-physician conversations about unnecessary medical tests and procedures.

“It’s been proven that CDS tools embedded within EHR systems improve provider compliance with practice guidelines and patient outcomes,” said Richesson. “However, if there is a gap in terminology and information models, it creates an issue in workflows for providers.”

Richesson said an example of this is when a diagnosis code from an EHR doesn’t exactly match the CDS logic and choosing a similar or “sibling” code is inappropriate. Her research will support automated approaches to provide meaningful and relevant information to providers for any number of conditions at the point of care. Having this type of provision for providers can limit the number of unnecessary procedures and increase patient safety, outcomes and satisfaction.

Traci Thoureen, MD, MHS-CL, FACEP, emergency physician for Duke University Health System and director of Emergency Medicine Simulation and associate medical director for the Duke Division of Emergency Medicine, will serve as co-investigator as well as domain clinical expert on the project. She will also serve as research champion to recruit other emergency department physicians and Duke EHR leadership for the project.

When the study concludes, Richesson and her team will propose to combine the metrics found during the research into a feasible assessment for CDS implementation that can be used by organizations to prioritize CDS projects. In addition, disease advocacy organizations and professional societies will be able to use it to identify CDS opportunities with the broadest potential for implementation and impact.

Scroll back to top automatically