Clinical informatics

December 13, 2019: EMBED Update: Challenges and Solutions (Edward Melnick, MD, Gail D’Onofrio, MD)

Posted on by Gina Uhlenbrauck

Speakers

Edward R. Melnick, MD, MHS
Assistant Professor of Emergency Medicine
Program Director, Yale-VA Clinical Informatics Fellowship Program
Principal Investigator, EMBED Trial

Gail D’Onofrio, MD
Professor & Chair
Department of Emergency Medicine
Yale School of Medicine

Topic

EMBED Update: Challenges and Solutions

Keywords

Embedded clinical research; Buprenorphine; EMBED; Opioid use disorder; Emergency department; Electronic health record; Clinical decision support tool; User-centered design; Clinical informatics

Key Points

  • Evidence shows that buprenorphine (BUP) treatment for patients with opioid use disorder (OUD) can safely and effectively be initiated from the emergency department (ED). As yet, BUP is rarely initiated as a part of routine ED care. Clinical decision support could accelerate adoption of ED-initiated BUP into routine emergency care.
  • The EMBED pragmatic trial is evaluating the effectiveness of a user-friendly, web-based clinical decision support tool to enable ED-initiated buprenorphine treatment for OUD. The goal is to optimize the tool’s usability, EHR integration, automation of EHR workflow, and scalability across a variety of healthcare systems.
  • EMBED is being conducted in 20 EDs across 5 healthcare systems.

Discussion Themes

The study team developed a computable phenotype to identify ED patients with OUD. Validation was conducted through physician chart review.

EMBED clinical decision support is a flexible tool that supports clinicians with varied levels of experience with the intervention by providing one-click options for direct activation of care pathways and user-activated support for critical decision points.

Newer versions of EHR systems have integrated pathways to allow for more automation of clinical decision support.

Read more about the challenges of the EMBED pragmatic trial and visit the EMBED web page.

Tags
#pctGR, @Collaboratory1

November 22, 2019: It’s Time to Learn From Patients Like Mine (Nigam H. Shah, MBBS, PhD)

Posted on by Gina Uhlenbrauck

Speaker

Nigam H. Shah, MBBS, PhD
Associate Professor of Medicine
Stanford University

Topic

It’s Time to Learn From Patients Like Mine

Keywords

Clinical informatics; Clinical data warehouse; Aggregate patient data; Consult service; Cohort search engine

Key Points

  • The “Green Button” service consists of software, data, and personnel. Multiple datasets are used in the analysis, along with a human filter.
  • The search engine can find matching patients by searching across diagnosis and procedure codes, concepts extracted from clinical notes, laboratory test results, vital signs, as well as visit types and duration of inpatient stays, and then compare their outcomes.
  • Questions that remain include:
    • Does having such a consult service change patient outcomes?
    • How could we enable such consults nationwide?
    • Could we automate such analyses to be “always on”?
    • Could we get such a “curbside consult” from multiple health systems?
    • Could patients benefit from having access to such reports?

Discussion Themes

Could this technology be applied in emergent, critical patient settings where the care is more diagnostic, and where predictive modeling using health system data could be helpful?

What’s missing from the data that would improve accuracy or relevance? For example, social, demographic, and environmental data.

Read more about Stanford’s Green Button clinical informatics consult project.

Tags
#pctGR, @Collaboratory1