An integrated web application for decision support and automation of EHR workflow: a case study of current challenges to standards-based messaging and scalability from the EMBED trial

Edward R Melnick, Wesley C Holland, Osama M Ahmed, Anthony K Ma, Sean S Michael, Howard S Goldberg, Christian Lagier, Gail D'Onofrio, Tomek Stachowiak, Cynthia Brandt, Yauheni Solad
2019 JAMIA Open  
Computerized clinical decision support (CDS) faces challenges to interoperability and scalability. Centralized, web-based solutions offer a mechanism to share the cost of CDS development, maintenance, and implementation across practices. Data standards have emerged to facilitate interoperability and rapid integration of such third-party CDS. This case report describes the challenges to implementation and scalability of an integrated, web-based CDS intervention for EMergency department-initiated
more » ... BuprenorphinE for opioid use Disorder which will soon be evaluated in a trial across 20 sites in five healthcare systems. Due to limitations of current standards, security concerns, and the need for resource-intensive local customization, barriers persist related to centralized CDS at this scale. These challenges demonstrate the need and importance for future standards to support two-way messaging (read and write) between electronic health records and web applications, thus allowing for more robust sharing across health systems and decreasing redundant, resource-intensive CDS development at individual sites.
doi:10.1093/jamiaopen/ooz053 pmid:32025639 pmcid:PMC6994013 fatcat:thv5rlo6k5a7fnz5vwanpncom4