Pilot Deployment of ePNa Into Epic EHR (ePNa-Epic)

Development of "SMART on FHIR (Fast Healthcare Interoperability Resources)" Interoperable Clinical Decision Support (CDS) for Emergency Department (ED) Patients With Pneumonia & Pilot Deployment Into Novel Epic Electronic Health Record (EHR) Environments

Intermountain Health has developed a electronic decision support tool to help doctors provide the best care for pneumonia. The purpose of this study is to enhance the existing tool (called ePneumonia (electronic Pneumonia) or ePNa) so that it can be used at other institutions, and to test deployment of the tool at another institution's hospitals.

Study Overview

• Status: Not yet recruiting
• Conditions: Pneumonia
• Intervention / Treatment: Other: ePNa

Detailed Description

This study as funded by the AHRQ (Agency for Healthcare Research and Quality) involves making the current ePNa system a "SMART on FHIR" compatible application that will enable the same core software and processes to work across the Cerner and Epic electronic health record platforms. The investigators will then engage with emergency department providers and patients to improve user centered design, considering clinician preferences and feedback for use as well as patient needs for information. Finally, the investigators will evaluate the feasibility and acceptability via a pilot implementation trial of the interoperable ePNa platform at two Vanderbilt affiliated hospitals.

• Study Type: Interventional
• Enrollment (Estimated): 6917
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Valerie Aston, MBA; Phone Number: 801-507-4606; Email: valerie.aston@imail.org
• Study Contact Backup: Name: David Tomer, MS; Phone Number: 801-507-4694; Email: David.Tomer@imail.org

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: Yes

Description

Inclusion Criteria:

For the baseline database and assessment of clinical outcomes, all data will be pulled from the Epic Clarity data warehouse.

• 2500 patients that presented to the Vanderbilt and Wilson county EDs who are >= 18 years old will be identified by ICD-10 codes for pneumonia or acute respiratory failure or sepsis with secondary pneumonia codes for the baseline database.
• An additional 2500 patients that presented to the Vanderbilt and Wilson county EDs who are >= 18 years old will be identified by having had conventional PA (posteroanterior) and lateral or portable CXRs (chest X-rays), independent of ICD-10 codes.
• During the one year pilot trial, patients seen in the 2 EDs, who are >= 18 years old will be identified by ICD(International Classification of Diseases)-10 codes for pneumonia or acute respiratory failure or sepsis with secondary pneumonia codes (estimated to comprise 1800 patients).

Exclusion Criteria:

For all above patients:

1. Patients seen with a history of recent trauma.
2. Subsequent episodes of pneumonia from the same patient within the study period.
3. Patients directly admitted to hospice/comfort care.
4. Patients admitted to a non-study hospital for further care.
5. Patients transferred from outside hospitals.

For the groups selected by ICD-10 pneumonia codes, an additional exclusion is:

• Patients without radiographic evidence of pneumonia or with clear radiographic evidence for an alternative diagnosis.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: N/A
• Interventional Model: Sequential Assignment
• Masking: None (Open Label)

Number of Arms

1

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Implementation at Vanderbilt University Medical Center (VUMC) & Vanderbilt Wilson County Hospital; ePNa (the decision support tool) will be implemented at 2 EDs that are part of the Vanderbilt Health system.	Other: ePNa; Real-time, automated clinical decision support tool for pneumonia (called "ePNa")

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
14-day hospital-free days	14-day hospital-free days (a metric which captures outpatient disposition from the emergency department, secondary hospital admission, and length of stay)	14 days after initial presentation to the emergency department

Secondary Outcome Measures

Outcome Measure	Time Frame
30-day all-cause mortality	At 30 days after initial ED presentation
ED length of stay (hours)	At ED discharge
ICU length of stay (days)	At ICU discharge
Number of patients admitted to floor who are subsequently transferred to ICU within 72 hours	At 72 hours after inpatient admission
Time from ED presentation to first antibiotic dose (minutes)	At time of first antibiotic dose

Collaborators and Investigators

• Sponsor: Nathan Dean
• Collaborators: Vanderbilt University; Stanford University; Agency for Healthcare Research and Quality (AHRQ)
• Investigators: Principal Investigator: Nathan Dean, MD, Intermountain Health

Study record dates

Study Major Dates

• Study Start (Estimated): February 1, 2025
• Primary Completion (Estimated): June 30, 2026
• Study Completion (Estimated): June 30, 2026

Study Registration Dates

• First Submitted: August 4, 2023
• First Submitted That Met QC Criteria: August 18, 2023
• First Posted (Actual): August 23, 2023

Study Record Updates

• Last Update Posted (Actual): September 28, 2023
• Last Update Submitted That Met QC Criteria: September 25, 2023
• Last Verified: September 1, 2023

More Information

Terms related to this study

• Keywords: Decision Support
• Additional Relevant MeSH Terms: Infections; Respiratory Tract Infections; Respiratory Tract Diseases; Lung Diseases; Pneumonia
• Other Study ID Numbers: 1052404

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No