TY  - JOUR
AU  - Sutton, Reed Taylor
AU  - Chappell, Kaitlyn Delaney
AU  - Pincock, David
AU  - Sadowski, Daniel
AU  - Baumgart, Daniel C
AU  - Kroeker, Karen Ivy
PY  - 2024
DA  - 2024/3/22
TI  - The Effect of an Electronic Medical Record–Based Clinical Decision Support System on Adherence to Clinical Protocols in Inflammatory Bowel Disease Care: Interrupted Time Series Study
JO  - JMIR Med Inform
SP  - e55314
VL  - 12
KW  - decision support system
KW  - clinical
KW  - electronic medical records
KW  - electronic health records
KW  - health record
KW  - medical record
KW  - EHR
KW  - EHRs
KW  - EMR
KW  - EMRs
KW  - decision support
KW  - CDSS
KW  - internal medicine
KW  - gastroenterology
KW  - gastrointestinal
KW  - implementation science
KW  - implementation
KW  - time series
KW  - interrupted time series analysis
KW  - inflammatory bowel disease
KW  - IBD
KW  - bowel
KW  - adherence
KW  - flare
KW  - flares
KW  - steroid
KW  - steroids
KW  - standardized care
KW  - nurse
KW  - clinical practice guidelines
KW  - chart
KW  - electronic chart
KW  - electronic medical chart
AB  - Background: Clinical decision support systems (CDSSs) embedded in electronic medical records (EMRs), also called electronic health records, have the potential to improve the adoption of clinical guidelines. The University of Alberta Inflammatory Bowel Disease (IBD) Group developed a CDSS for patients with IBD who might be experiencing disease flare and deployed it within a clinical information system in 2 continuous time periods. Objective: This study aims to evaluate the impact of the IBD CDSS on the adherence of health care providers (ie, physicians and nurses) to institutionally agreed clinical management protocols. Methods: A 2-period interrupted time series (ITS) design, comparing adherence to a clinical flare management protocol during outpatient visits before and after the CDSS implementation, was used. Each interruption was initiated with user training and a memo with instructions for use. A group of 7 physicians, 1 nurse practitioner, and 4 nurses were invited to use the CDSS. In total, 31,726 flare encounters were extracted from the clinical information system database, and 9217 of them were manually screened for inclusion. Each data point in the ITS analysis corresponded to 1 month of individual patient encounters, with a total of 18 months of data (9 before and 9 after interruption) for each period. The study was designed in accordance with the Statement on Reporting of Evaluation Studies in Health Informatics (STARE-HI) guidelines for health informatics evaluations. Results: Following manual screening, 623 flare encounters were confirmed and designated for ITS analysis. The CDSS was activated in 198 of 623 encounters, most commonly in cases where the primary visit reason was a suspected IBD flare. In Implementation Period 1, before-and-after analysis demonstrates an increase in documentation of clinical scores from 3.5% to 24.1% (P<.001), with a statistically significant level change in ITS analysis (P=.03). In Implementation Period 2, the before-and-after analysis showed further increases in the ordering of acute disease flare lab tests (47.6% to 65.8%; P<.001), including the biomarker fecal calprotectin (27.9% to 37.3%; P=.03) and stool culture testing (54.6% to 66.9%; P=.005); the latter is a test used to distinguish a flare from an infectious disease. There were no significant slope or level changes in ITS analyses in Implementation Period 2. The overall provider adoption rate was moderate at approximately 25%, with greater adoption by nurse providers (used in 30.5% of flare encounters) compared to physicians (used in 6.7% of flare encounters). Conclusions: This is one of the first studies to investigate the implementation of a CDSS for IBD, designed with a leading EMR software (Epic Systems), providing initial evidence of an improvement over routine care. Several areas for future research were identified, notably the effect of CDSSs on outcomes and how to design a CDSS with greater utility for physicians. CDSSs for IBD should also be evaluated on a larger scale; this can be facilitated by regional and national centralized EMR systems. 
SN  - 2291-9694
UR  - https://medinform.jmir.org/2024/1/e55314
UR  - https://doi.org/10.2196/55314
DO  - 10.2196/55314
ID  - info:doi/10.2196/55314
ER  -