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Special Collection: HCSRN Special Collection

Empirical research

Development of a Clinical Decision Support System for Pediatric Abdominal Pain in Emergency Department Settings Across Two Health Systems Within the HCSRN

Authors:

Heidi L. Ekstrom ,

HealthPartners Institute, Minneapolis, Minnesota, US
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Elyse O. Kharbanda,

HealthPartners Institute, Minneapolis, Minnesota, US
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Dustin W. Ballard,

The Permanente Medical Group, Oakland, California; Kaiser Permanente Division of Research, Oakland, California, US
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David R. Vinson,

The Permanente Medical Group, Oakland, California; Kaiser Permanente Division of Research, Oakland, California, US
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Gabriela Vazquez-Benitez,

HealthPartners Institute, Minneapolis, Minnesota, US
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Uli K. Chettipally,

The Permanente Medical Group, Oakland, California, US
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Steven P. Dehmer,

HealthPartners Institute, Minneapolis, Minnesota, US
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Gopikrishna Kunisetty,

HealthPartners Institute, Minneapolis, Minnesota, US
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Rashmi Sharma,

HealthPartners Institute, Minneapolis, Minnesota, US
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Adina S. Rauchwerger,

Kaiser Permanente Division of Research, Oakland, California, US
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Patrick J. O'Connor,

HealthPartners Institute, Minneapolis, Minnesota, US
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Anupam B. Kharbanda

Children's Hospitals and Clinics, US
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Abstract

Background: Appendicitis is a common surgical emergency in children, yet diagnosis can be challenging. An electronic health record (EHR) based, clinical decision support (CDS) system called Appy CDS was designed to help guide management of pediatric patients with acute abdominal pain within the Health Care Systems Research Network (HCSRN).

Objectives: To describe the development and implementation of a clinical decision support tool (Appy CDS) built independently but synergistically at two large HCSRN affiliated health systems using well-established platforms, and to assess the tool’s Triage component, aiming to identify pediatric patients at increased risk for appendicitis.

Results: Despite differences by site in design and implementation, such as the use of alerts, incorporating gestalt, and other workflow variations across sites, using simple screening questions and automated exclusions, both systems were able to identify a population with similar appendicitis rates (11.8 percent and 10.6 percent), where use of the full Appy CDS would be indicated.

Discussion: These 2 HCSRN sites designed Appy CDS to capture a population at risk for appendicitis and deliver CDS to that population while remaining locally relevant and adhering to organizational preferences. Despite different approaches to point-of-care CDS, the sites have identified similar cohorts with nearly identical background rates of appendicitis.

Next Steps: The full Appy CDS tool, providing personalized risk assessment and tailored recommendations, is undergoing evaluation as part of a pragmatic cluster randomized trial aiming to reduce reliance on advanced diagnostic imaging. The novel approaches to CDS we present could serve as the basis for future ED interventions.

How to Cite: Ekstrom HL, Kharbanda EO, Ballard DW, Vinson DR, Vazquez-Benitez G, Chettipally UK, et al.. Development of a Clinical Decision Support System for Pediatric Abdominal Pain in Emergency Department Settings Across Two Health Systems Within the HCSRN. eGEMs (Generating Evidence & Methods to improve patient outcomes). 2019;7(1):15. DOI: http://doi.org/10.5334/egems.282
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  Published on 12 Apr 2019

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