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CC BY-NC-ND 4.0 · Yearb Med Inform 2022; 31(01): 184-198
DOI: 10.1055/s-0042-1742518
Section 6: Decision Support
Survey

Electronic Health Record-Integrated Clinical Decision Support for Clinicians Serving Populations Facing Health Care Disparities: Literature Review

Carole H. Stipelman
1   Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT, USA
2   Health Informatics, University of Utah School of Medicine, Salt Lake City, UT, USA
,
Polina V. Kukhareva
3   Department of Biomedical Informatics, University of Utah School of Medicine, Salt Lake City, UT, USA
,
Elly Trepman
4   Department of Medical Microbiology and Infectious Diseases, University of Manitoba, Winnipeg, MB, Canada
5   University of South Alabama College of Medicine, Mobile, AL, USA
,
Quang-Tuyen Nguyen
1   Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT, USA
,
Lourdes Valdez
3   Department of Biomedical Informatics, University of Utah School of Medicine, Salt Lake City, UT, USA
,
Colleen Kenost
3   Department of Biomedical Informatics, University of Utah School of Medicine, Salt Lake City, UT, USA
,
Maia Hightower
2   Health Informatics, University of Utah School of Medicine, Salt Lake City, UT, USA
3   Department of Biomedical Informatics, University of Utah School of Medicine, Salt Lake City, UT, USA
6   Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
,
Kensaku Kawamoto
3   Department of Biomedical Informatics, University of Utah School of Medicine, Salt Lake City, UT, USA
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Summary

Objectives: To review current studies about designing and implementing clinician-facing clinical decision support (CDS) integrated or interoperable with an electronic health record (EHR) to improve health care for populations facing disparities.

Methods: We searched PubMed to identify studies published between January 1, 2011 and October 22, 2021 about clinician-facing CDS integrated or interoperable with an EHR. We screened abstracts and titles and extracted study data from articles using a protocol developed by team consensus. Extracted data included patient population characteristics, clinical specialty, setting, EHR, clinical problem, CDS type, reported user-centered design, implementation strategies, and outcomes.

Results: There were 28 studies (36 articles) included. Most studies were performed at safety net institutions (14 studies) or Indian Health Service sites (6 studies). CDS tools were implemented in primary care outpatient settings in 24 studies (86%) for screening or treatment. CDS included point-of-care alerts (93%), order facilitators (46%), workflow support (39%), relevant information display (36%), expert systems (11%), and medication dosing support (7%). Successful outcomes were reported in 19 of 26 studies that reported outcomes (73%). User-centered design was reported during CDS planning (39%), development (32%), and implementation phase (25%). Most frequent implementation strategies were education (89%) and consensus facilitation (50%).

Conclusions: CDS tools may improve health equity and outcomes for patients who face disparities. The present review underscores the need for high-quality analyses of CDS-associated health outcomes, reporting of user-centered design and implementation strategies used in low-resource settings, and methods to disseminate CDS created to improve health equity.

Keywords

Equity - screening - vulnerable populations - medically underserved - safety net

Supplementary Material



Publication History

Article published online:
04 December 2022

© 2022. IMIA and Thieme. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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