Table 4 Responses from the internally-developed EHR systems
Questions | Partners | Regenstrief | Intermountain Health Care | Veterans' Health Administration |
|---|---|---|---|---|
CIS modules offered (products that have capability to provide decision support)? | Yes, CPOE, results review, laboratory, outpatient clinical documentation, eMAR, Drug-Drug/Allergy/Lab Interaction checking. BCMA | Yes, CPOE, consults from specialists. Documentation: patient visit notes, ADT summaries, problem lists. Links to test results, notes | Yes, Antibiotic, TPN; Results review; RN, RT, Pharmacist charting; Infection & Disease monitoring, ADR triggers, VTE high risk alerts | Yes, Order menus, sets, quick orders. documentation. Templates. Drug-Drug/Allergy/Lab Interaction checking. BCMA |
EHR delivery model? | Onsite | Onsite | Onsite (Server and web based) | Onsite (move to regional server) |
CDS content implemented/configured/maintained by customer or vendor? | maintained by informaticians. Most content separate from code viewed thru repository | Clinician/Informaticians update terminology and decision support rules as needed | Users responsible for content. Programmers logic. Updated weekly, larger updates quarterly | CDS maintained, implemented locally. National releases with local configuration. |
Collect structured data and which controlled vocabularies? | LOINC, RxNorm, SNOMED, ICD-9, CPT, FDB | ICD-9 & CPT codes avail. Most entered via Regenstrief Dict. mapped to standard vocabs. | Mostly coded data, some dictated notes as free text. LOINC, SNOMED, ICD-9 | Not from clinician notes, but reminder templates do. ICD-9 for problem list |
Support ad-hoc queries? Live replicating database? | Yes. Yes, weekly to monthly depending on data element | Queries done by data analysts on real database, in response to requests from end users. | Yes, but most reports run on EDW from programmers. Have some canned reports monthly | Yes, use replicated DB, varied update frequency; ProClarity data cubes |
HL7 InfoButton? | Yes | No | Yes | No, but something similar |
Arden Syntax for MLM? | No | No. Gopher Care Rules corresponds to Arden Syntax. | No (some graduate projects) | No |
Clinical knowledge editor for user to create CDS? | Yes | Editor used by infomaticians to create CDS | Ability for knowledgeable users to create CDS | Not by end user. Some local configuration by support staff |
Content mgmt system separate from EHR? | Yes | No | Online K repository, most review/updates programmers | No. Pilots are ongoing. |
Reporting capability to track effect/usage of CDS content? | Yes | User responses prospectively, not retrospective | Yes, from reports in the EDW | Yes, focused on performance measures not CDS usage |
Drug database supplier? | FDB | In-house drug terms | FDB | Internal Drug/Allergy files |
3rd party CDS content vendors? | Thompson Micromedex, UpToDate | No | MicroMedex through Info-buttons | MicroMedex, UpToDate, etc. at point of care |
Provide clinical content (starter sets). What content is included, how and how often and is it updated? | CDS content provided and maintained by the Informatics groups. Updates distributed on an as needed basis. | Alerts, drug-drug. Formulary, price. Order sets. Default drug strengths, frequencies, or instructions. updates mult/yr. | All alert logic is provided, developed, and maintained by institution. weekly and quarterly updates | Local development of reminders, order menus, document templates. |
On-line collaborative knowledge development environment web 2.0? | Yes | No | No | Yes, starting SharePoint sites for national groups |
Internet repository for clients to share locally generated CDS? | No | No | No | Some networks have web sites to share CDS |