ePneumonia: Development of an Electronic Clinical Decision Support System for Community-Onset Pneumonia



Status:Recruiting
Conditions:Pneumonia
Therapuetic Areas:Pulmonary / Respiratory Diseases
Healthy:No
Age Range:18 - Any
Updated:7/12/2018
Start Date:November 22, 2017
End Date:June 1, 2021
Contact:Nathan Dean, MD
Email:nathan.dean@imail.org
Phone:(801) 507-4696

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The investigators plan to further develop a prototype, evidence-based, electronic clinical
decision support system (CDSS) for pneumonia care (ePneumonia) with interoperability across
Electronic Health Records in order to improve clinical outcomes and reduce healthcare
resource utilization. The specific aims of this study are to evaluate the usability of
ePneumonia adapted for Cerner and its impact on clinical, patient-centered and healthcare
resource utilization outcomes in a stepped-wedge implementation study in 16 hospital
emergency departments (EDs) across the Intermountain Healthcare integrated health system.

Since the launch of a paper-based pneumonia care process model in 1994, decision support for
pneumonia care has been under continuous development at Intermountain. Studies published in
2001 and 2006 demonstrated decreased mortality using paper-based methods. An electronic
pneumonia Clinical Decision Support System was later developed in the original Intermountain
computing environment and implemented in 4 regional emergency departments (ED) in 2011. This
tool featured a novel mortality predictor and real-time synthesis of clinical data to guide
diagnosis, risk stratification, admission triage and guideline-concordant treatment. An
outcome study published in 2015 demonstrated reduction in mortality with tool use compared to
usual care. Most recently, Intermountain researchers led by study co-Investigator, Dr.
Brandon Webb, developed an innovative tool to predict risk of drug-resistant bacteria and
demonstrated its potential to improve antibiotic use and outcomes.

The investigators have entered a robust phase of additional development and adaptation of
ePneumonia into the Cerner Electronic Health Record (EHR) system. The objective of this study
is to advance development of an evidence-based, electronic CDSS for pneumonia care with
interoperability across EHRs in order to improve clinical outcomes and reduce healthcare
resource utilization. The specific aim of this study is to evaluate the usability of
ePneumonia and its associated impact on clinical, patient-centered and healthcare resource
utilization outcomes in a stepped-wedge implementation study in 16 hospital EDs in the
Intermountain Healthcare integrated health system.

- Hypothesis #1: Healthcare providers will affirm ePneumonia usability, lack of
interference with clinical workflow and only minor unintended consequences of use.

- Hypothesis #2: In patients with community-onset pneumonia, ePneumonia use will improve
clinical and patient-centered outcomes and decrease healthcare resource utilization.

One year of baseline clinical outcome data will be gathered for all 16 emergency departments.
The first of 6 clusters of ED's will begin prospective data collection in January 2018, with
the remaining coming on at 2 month intervals until ePneumonia has been deployed at all sites.
An additional 1 year of data collection will be continued through 2019.

Inclusion Criteria:

- All patients ≥ 18 years who are identified by either (2a) ICD-10 codes for pneumonia;
or acute respiratory failure or sepsis with secondary pneumonia codes or (2b)
clinician completion of ePneumonia for Cerner.

- Intermountain Healthcare physicians working in the 16 ED's

Exclusion Criteria:

- Patients without radiographic confirmation of pneumonia

- subsequent episodes of pneumonia within the study period, so as not to over-represent
patients with recurrent pneumonia caused by recurrent aspiration or structural lung
disease, and

- immunosuppressed patients, such as those with AIDS.
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900 Round Valley Drive
Park City, Utah 84060
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American Fork, Utah 84003
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1501 Hiland Avenue
Burley, Idaho 83318
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1303 North Main Street
Cedar City, Utah 84721
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126 White Sage Avenue
Delta, Utah 84624
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Fillmore, Utah 84631
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1485 U.S. 40
Heber, Utah 84032
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500 E 1400 N
Logan, Utah 84341
(435) 716-1000
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Logan Regional Hospital Logan Regional Hospital is a nonprofit, full-service regional medical center and level...
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1100 South Medical Drive
Mount Pleasant, Utah 84647
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5121 S Cottonwood St
Murray, Utah 84157
(801) 507-7000
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Intermountain Medical Center Intermountain Medical Center is one of the most technologically advanced and patient-friendly...
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Ogden, Utah
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Orem, Utah 84057
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200 North 400 East Street
Panguitch, Utah 84759
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1134 North 500 West
Provo, Utah 84604
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1000 North Main Street
Richfield, Utah 84701
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Saint George, Utah 84770
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905 North 1000 West
Tremonton, Utah 84337
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