Use of Electronic Health Records to Develop and Implement a Silent Best Practice Alert Notification System for Patient Recruitment in Clinical Research: Quality Improvement Initiative.

Connor Devoe,Kamal Jethwani,Harriett Gabbidon,Lauren Cortese,Nina Schussler,Stephen Agboola,Colin Gorman,Emily Caplan,Joseph Kvedar

doi:10.2196/10020

Connor Devoe, Kamal Jethwani + Show 7 more

Open Access

https://doi.org/10.2196/10020

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Abstract

BackgroundParticipant recruitment, especially for frail, elderly, hospitalized patients, remains one of the greatest challenges for many research groups. Traditional recruitment methods such as chart reviews are often inefficient, low-yielding, time consuming, and expensive. Best Practice Alert (BPA) systems have previously been used to improve clinical care and inform provider decision making, but the system has not been widely used in the setting of clinical research.ObjectiveThe primary objective of this quality-improvement initiative was to develop, implement, and refine a silent Best Practice Alert (sBPA) system that could maximize recruitment efficiency.MethodsThe captured duration of the screening sessions for both methods combined with the allotted research coordinator hours in the Emerald-COPD (chronic obstructive pulmonary disease) study budget enabled research coordinators to estimate the cost-efficiency.ResultsPrior to implementation, the sBPA system underwent three primary stages of development. Ultimately, the final iteration produced a system that provided similar results as the manual Epic Reporting Workbench method of screening. A total of 559 potential participants who met the basic prescreen criteria were identified through the two screening methods. Of those, 418 potential participants were identified by both methods simultaneously, 99 were identified only by the Epic Reporting Workbench Method, and 42 were identified only by the sBPA method. Of those identified by the Epic Reporting Workbench, only 12 (of 99, 12.12%) were considered eligible. Of those identified by the sBPA method, 30 (of 42, 71.43%) were considered eligible. Using a side-by-side comparison of the sBPA and the traditional Epic Reporting Workbench method of screening, the sBPA screening method was shown to be approximately four times faster than our previous screening method and estimated a projected 442.5 hours saved over the duration of the study. Additionally, since implementation, the sBPA system identified the equivalent of three additional potential participants per week.ConclusionsAutomation of the recruitment process allowed us to identify potential participants in real time and find more potential participants who meet basic eligibility criteria. sBPA screening is a considerably faster method that allows for more efficient use of resources. This innovative and instrumental functionality can be modified to the needs of other research studies aiming to use the electronic medical records system for participant recruitment.

Highlights

Clinical research is critical to our understanding of disease etiology and the development of novel therapeutics, a commonly encountered problem in clinical trials is the challenge of meeting enrollment targets in the stipulated time
418 potential participants were identified by both methods simultaneously, 99 were identified only by the Epic Reporting Workbench Method, and 42 were identified only by the silent Best Practice Alert (sBPA) method
Since implementation, the sBPA system identified the equivalent of three additional potential participants per week

Summary

Introduction

Clinical research is critical to our understanding of disease etiology and the development of novel therapeutics, a commonly encountered problem in clinical trials is the challenge of meeting enrollment targets in the stipulated time. Participants who provided reasons stated they were too tired, too sick, or no longer interested, among others [3]. Given these recruitment challenges, it is imperative to find novel strategies to facilitate participant recruitment in clinical trials. Participant recruitment, especially for frail, elderly, hospitalized patients, remains one of the greatest challenges for many research groups. Traditional recruitment methods such as chart reviews are often inefficient, low-yielding, time consuming, and expensive. Best Practice Alert (BPA) systems have previously been used to improve clinical care and inform provider decision making, but the system has not been widely used in the setting of clinical research

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