Using REDCap and Apple ResearchKit to integrate patient questionnaires and clinical decision support into the electronic health record to improve sexually transmitted infection testing in the emergency department

Fahd A Ahmad; Philip R O Payne; Ian Lackey; Rachel Komeshak; Kenneth Kenney; Brianna Magnusen; Christopher Metts; Thomas Bailey

doi:10.1093/jamia/ocz182

Using REDCap and Apple ResearchKit to integrate patient questionnaires and clinical decision support into the electronic health record to improve sexually transmitted infection testing in the emergency department

J Am Med Inform Assoc. 2020 Feb 1;27(2):265-273. doi: 10.1093/jamia/ocz182.

Authors

Fahd A Ahmad¹, Philip R O Payne^{2

3}, Ian Lackey², Rachel Komeshak², Kenneth Kenney¹, Brianna Magnusen², Christopher Metts⁴, Thomas Bailey³

Affiliations

¹ Department of Pediatrics, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA.
² Institute for Informatics, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA.
³ Department of Medicine, Washington School of Medicine University in St. Louis, St. Louis, Missouri, USA.
⁴ Department of Pathology and Laboratory Medicine, Medical University of South Carolina, Charleston, South Carolina, USA.

Abstract

Objective: Audio-enhanced computer-assisted self-interviews (ACASIs) are useful adjuncts for clinical care but are rarely integrated into the electronic health record (EHR). We created a flexible framework for integrating an ACASIs with clinical decision support (CDS) into the EHR. We used this program to identify adolescents at risk for sexually transmitted infections (STIs) in the emergency department (ED). We provide an overview of the software platform and qualitative user acceptance.

Materials and methods: We created an ACASI with a CDS algorithm to identify adolescents in need of STI testing. We offered it to 15- to 21-year-old patients in our ED, regardless of ED complaint. We collected user feedback via the ACASI. These were programmed into REDCap (Research Electronic Data Capture), and an iOS application utilizing Apple ResearchKit generated a tablet compatible representation of the ACASI for patients. A custom software program created an HL7 (Health Level Seven) message containing a summary of responses, CDS recommendations, and STI test orders, which were transmitted to the EHR.

Results: In the first year, 1788 of 6227 (28.7%) eligible adolescents completed the survey. Technical issues led to decreased use for several months. Patients rated the system favorably, with 1583 of 1787 (88.9%) indicating that they were "somewhat" or "very comfortable" answering questions electronically and 1291 of 1787 (72.2%) preferring this format over face-to-face interviews or paper questionnaires.

Conclusions: We present a novel use for REDCap to combine patient-answered questionnaires and CDS to improve care for adolescents at risk for STIs. Our program was well received and the platform can be used across disparate patients, topics, and information technology infrastructures.

Keywords: REDCap; clinical decision support; electronic health record; emergency care; sexually transmitted diseases.

Publication types

Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

MeSH terms

Adolescent
Attitude of Health Personnel
Attitude to Computers
Attitude to Health
Decision Support Systems, Clinical*
Electronic Health Records*
Emergency Service, Hospital
Female
Humans
Male
Sexually Transmitted Diseases / diagnosis*
Surveys and Questionnaires*
Young Adult

Abstract

Publication types

MeSH terms

Grants and funding