Identifying critically ill patients at risk for inappropriate antibiotic therapy: a pilot study of a point-of-care decision support alert.

Objective: To develop an automated alert aimed at reducing inappropriate antibiotic therapy of serious healthcare-associated infections.

Design: Single-center cohort study from November 2011 to November 2012.

Setting: Barnes-Jewish Hospital (1,250-bed academic hospital).

A trial of a real-time alert for clinical deterioration in patients hospitalized on general medical wards.

Background: With limited numbers of intensive care unit (ICU) beds available, increasing patient acuity is expected to contribute to episodes of inpatient deterioration on general wards.

Objective: To prospectively validate a predictive algorithm for clinical deterioration in general-medical ward patients, and to conduct a trial of real-time alerts based on this algorithm.

Design: Randomized, controlled crossover study.

Computerized surveillance for adverse drug events in a pediatric hospital.

There are limited data on adverse drug event rates in pediatrics. The authors describe the implementation and evaluation of an automated surveillance system modified to detect adverse drug events (ADEs) in pediatric patients. The authors constructed an automated surveillance system to screen admissions to a large pediatric hospital.

Improving adherence to dyslipidemia medication guidelines in hospitalized diabetic patients using a technology-assisted pharmacist intervention.

We tested whether a technology-assisted pharmacist intervention improved physician adherence to guidelines for lipid-lowering therapy in diabetic patients. Computerized alerts identified diabetic patients above LDL-Cholesterol (LDL-C) goal. During Period 1 prescribing behavior was observed in both control and intervention physician groups without intervening.

Computerized surveillance for adverse drug events in a pediatric hospital.

Adverse drug event (ADE) surveillance is needed to inform processes and methods for prevention. Voluntary reporting and manual chart review have limitations. Automated surveillance systems are gaining recognition and provide useful information to supplement the other methods.

Alerts to improve chart documentation for National Quality Measures.

Clinical decision support (CDS) rules monitoring adherence to guidelines for secondary prevention of acute myocardial infarction (AMI) have been in use at BJC HealthCare's academic facility for five years. The alert web response form for these rules was enhanced to facilitate documentation of contraindications for ACE/ARB, beta blocker, aspirin, and lipid-lowering medications. An analysis of the impact of these enhancements and the changes to pharmacy workflow are presented here.

Migrating toward a next-generation clinical decision support application: the BJC HealthCare experience.

The next-generation model outlined in the AMIA Roadmap for National Action on Clinical Decision Support (CDS) is aimed to optimize the effectiveness of CDS interventions, and to achieve widespread adoption. BJC HealthCare re-engineered its existing CDS system in alignment with the AMIA roadmap and plans to use it for guidance on further enhancements. We present our experience and discuss an incremental approach to migrate towards the next generation of CDS applications from the viewpoint of a healthcare institution.

Implementation of virtual medical record object model for a standards-based clinical decision support rule engine.

The Virtual Medical Record (vMR) is a structured data model for representing individual patient informations. Our implementation of vMR is based on HL7 Reference Information Model (RIM) v2.13 from which a minimum set of objects and attributes are selected to meet the requirement of a clinical decision support (CDS) rule engine.

Using BPEL to define an executable CDS rule process.

Business Process Execution Language for Web Services (BPEL) is an XML-based language used to define business process and workflow logic. While its original purpose was to provide a method of linking several disparate business applications, we have found that BPEL provides several features and advantages that lend it to incorporation in a clinical decision support (CDS) rule engine.