Abstract
Background
Many children with cancer are treated as part of interventional clinical trials. Ensuring
that the correct chemotherapy treatment plan is used is paramount.
Objectives
The objectives of this report were to: (1) highlight the initial design of a clinical
decision support (CDS) tool that was intended to help ensure the correct matching
of research studies to research chemotherapy medications, (2) discuss the issues identified
with the CDS tool, and (3) review the redesign of the tool that was done to overcome
the issues identified.
Methods
We previously utilized an interruptive alert developed by Epic Systems to identify
mismatches between a patient's chemotherapy plan and research study. We identified
an issue with the logic of the alert resulting in the alert firing inappropriately.
Results
We estimate that the chemotherapy-research plan alert fired when 93.4% of treatment
plans were applied (17.3 alerts/provider/year). A high number of misfiring alerts
were identified due to the inclusion of our institution name as both (1) a “tag” in
the research protocol, and (2) an unallowed tag in the research study record. Since
the tag was included in all protocols, but also unallowed in all research records
the alert fired with the application of almost all treatment plans. We developed a
new mechanism to provide CDS that did not involve an interruptive alert. Within the
research study record, we manually associate compatible treatment plans to that study
record, and then when an oncologist goes to order chemotherapy the system prioritizes
the display of compatible treatment plans to the oncologist. The goal of the redesigned
CDS approach is to eliminate interruptive alerts while ensuring the correct chemotherapy
plan is selected.
Conclusion
With end-user engagement and creative approaches to CDS design, interruptive alerts
can be transitioned into passive and effective CDS tools.
Keywords
pediatrics - chemotherapy - clinical decision support - oncology - clinical trial
