Accepted for/Published in: JMIR Medical Informatics
Date Submitted: Jan 12, 2023
Open Peer Review Period: Jan 12, 2023 - Mar 9, 2023
Date Accepted: Oct 18, 2023
(closed for review but you can still tweet)
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
Design and Implementation of Clinical Decision Support using SMART on FHIR
ABSTRACT
Background:
Clinical decision support (CDS) has the potential to improve clinical decision making consistent with evidence-based care. CDS can be designed to save providers time and help them provide safe and personalized analgesic prescribing.
Objective:
To describe the development and implementation of a clinical decision support system (CDS) designed to provide dentists with personalized pain management recommendations for patients at the point of care using electronic health record (EHR) information.
Methods:
HealthPartners Dental Group uses an EHR system that integrates both medical and dental information upon which the SMART on FHIR based CDS application was developed. The CDS draws upon best evidence data and patient characteristics to help dentists with decisions regarding pain management related to dental extractions. The CDS application runs a home-grown drug interaction algorithm against a patient’s medical history and provides patient-specific recommendations. We utilized RxNorm level codes and NLM RxNorm API to obtain ingredient-level information for the patient’s medication list. The CDS included access to the state Prescription Monitoring Program database.
Results:
The pain management CDS was implemented as part of a study examining opioid prescribing among patients undergoing dental extraction procedures from 2/17/20 - 5/14/21. Among the 20 clinics with providers assigned to the intervention arms, 95.0% (19/20) had at least one extraction encounter with the CDS opened. The app was opened more frequently by general dentists than oral surgeons.
Conclusions:
The pain management CDS is an EHR-embedded, provider-facing tool to help dentists make personalized pain management recommendations following dental extractions. The SMART on FHIR based pain management CDS adapted well into the point-of-care dental setting and helped us to design a scalable CDS tool that is EHR vendor-agnostic. Clinical Trial: Clinicaltrials.gov NCT03584789
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Copyright
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