Electronic Health Record Tools for Bronchiolitis

Recruiting at 3 trial locations

Overseen By Benjamin Bodnar, MD

Age: < 18

Sex: Any

Trial Phase: Academic

Sponsor: Johns Hopkins University

Disqualifiers: Birth encounter, ICU, >14 days

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: Unknown

Duration: 2-4 days

800 Participants Needed

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial explores how electronic health record tools can help doctors provide better care for children with bronchiolitis, a common lung infection in young children. Researchers are testing whether different types of alerts, called best practice advisories (BPAs), embedded in the electronic health record can guide doctors to follow established care guidelines more closely. The study compares outcomes in three groups: those whose doctors receive no alert, a less intrusive alert, or a more disruptive alert. Children under 2 years old who are hospitalized with bronchiolitis may be suitable candidates for this trial. As an unphased trial, this study offers a unique opportunity to contribute to improving healthcare practices for young children.

Will I have to stop taking my current medications?

The trial information does not specify whether participants must stop taking their current medications. It seems that patients will continue to receive standard hospital care for bronchiolitis, so it's likely that any changes to medication would be part of that standard care.

What prior data suggests that these electronic health record tools are safe for use in bronchiolitis care?

Previous studies have used both interruptive and non-interruptive BPAs (best practice advisories) in electronic health records to encourage doctors to follow bronchiolitis treatment guidelines. These studies have not reported any direct safety concerns for patients, as the BPAs are simply alerts or reminders in the electronic health record system. They assist doctors in making decisions based on established guidelines.

These BPAs do not involve administering a new drug or treatment directly to patients. Instead, they guide doctors in providing care, with no known adverse effects or safety issues for patients from the BPAs themselves. The main focus is on improving adherence to existing treatment guidelines, making the care process smoother and more aligned with best practices. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about this trial because it explores innovative ways to enhance bronchiolitis care using Electronic Health Record (EHR) tools. Unlike traditional treatments that rely solely on clinical decision-making without digital assistance, this trial examines how different types of Best Practice Alerts (BPAs) can guide clinicians more effectively. The interruptive BPA actively prompts clinicians to check evidence-based guidelines, potentially improving adherence and outcomes, while the non-interruptive BPA offers a subtler reminder, integrating seamlessly into the workflow. By leveraging these EHR tools, the trial aims to refine and optimize decision-making processes in treating bronchiolitis, potentially leading to more consistent and evidence-based care.

What evidence suggests that these BPAs are effective for improving bronchiolitis care?

Research has shown that electronic health record (EHR) tools, such as non-interruptive best practice advisories (BPAs), can enhance care for bronchiolitis. In this trial, some clinicians will encounter non-interruptive BPAs, which have reduced unnecessary and costly tests without overwhelming doctors with alerts. Studies also indicate that these tools can decrease ineffective treatments, ensuring that children with bronchiolitis receive care aligned with best practices. Meanwhile, other clinicians in this trial will use interruptive BPAs, which also guide doctors toward optimal bronchiolitis treatment. A control group, where clinicians will not use a BPA, will allow comparison of the interventions' effectiveness. ^{1 2 4 6 7}

Who Is on the Research Team?

Benjamin Bodnar, MD

Principal Investigator

Johns Hopkins University

Are You a Good Fit for This Trial?

This trial is for children hospitalized with bronchiolitis. There are no specific inclusion or exclusion criteria provided, suggesting that the study may be broadly applicable to pediatric patients admitted with this condition.

Inclusion Criteria

Physicians and advanced practice providers entering the patient's chart or orders entry activity for Emergency Department (ED) and inpatient encounters

My child, 24 months or younger, is in the hospital with bronchiolitis.

Exclusion Criteria

Physicians and advanced practice providers who do not enter the patient's chart or orders entry activity

Current encounter is birth-encounter

I am currently in an intensive care unit.

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

1-2 weeks

Treatment

Patients receive standard hospital care for bronchiolitis with exposure to different types of BPAs

2-4 days

Inpatient hospital stay

Follow-up

Participants are monitored for safety and effectiveness after treatment

1 week

What Are the Treatments Tested in This Trial?

Interventions

• Leveraging Electronic Health Record Tools

Trial Overview The study tests if best practice advisories (BPAs) in electronic health records help doctors follow guidelines for treating bronchiolitis. It compares no BPA, non-interruptive BPA, and interruptive BPA's effects on care quality.

How Is the Trial Designed?

Group I: Non-interruptive BPA Experimental Treatment 1 Intervention

Clinicians will be exposed to an non-interruptive BPA directing the clinician to reference the EHR-embedded, evidence-based clinical guideline for the care of bronchiolitis.

Group II: Interruptive BPA Experimental Treatment 1 Intervention

Clinicians will be exposed to an interruptive BPA directing the clinician to reference the EHR-embedded, evidence-based clinical guideline for the care of bronchiolitis.

Group III: No BPA Active Control 1 Intervention

Clinicians will not be exposed to a BPA about the care of bronchiolitis. The participants will still have access to the EHR-embedded, evidence-based clinical guideline.

Who Is Running the Clinical Trial?

Johns Hopkins University

Lead Sponsor

Trials

2,366

Recruited

15,160,000+

Published Research Related to This Trial

Out of 9,000 patient safety reports analyzed from 2012 to 2017, 36% identified usability issues related to electronic health records (EHRs) that contributed to medication events, highlighting significant safety concerns in pediatric care.

Among the usability issues, the most frequent problems were related to system feedback and visual display, with improper dosing being the most common medication error, indicating critical areas for improvement in EHR design to enhance safety for children.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Identifying Electronic Health Record Usability And Safety Challenges In Pediatric Settings. Ratwani, RM., Savage, E., Will, A., et al.[2019]

Citations

1. clinicaltrials.gov clinicaltrials.gov/study/NCT06932341

Leveraging Electronic Health Record Tools to Improve the ... Researchers will compare the treatment and outcomes of patients whose clinicians did not receive a BPA, to those whose clinicians received a non-interruptive ...

2. mcri.figshare.com mcri.figshare.com/articles/journal_contribution/Impact_of_an_Intervention_to_Reduce_Bronchodilator_Use_in_Bronchiolitis_-_A_Time_Series_Analysis_/26240561/1/files/47561132.pdf

Impact of an Intervention to Reduce Bronchodilator Use in ... CONCLUSIONS: We found that the multifaceted intervention, including an EMR alert, may be an effective method of reducing low value care prescribing in ...

3. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC10873857/

Retrospective analysis of the impact of electronic medical ... This study aimed to understand whether electronic medical record (EMR) alerts are effective at reducing pediatric LVC and measure the impact on hospital costs.

4. trial.medpath.com trial.medpath.com/clinical-trial/16cca2c286979bb0/electronic-health-record-bronchiolitis-treatment

Leveraging Electronic Health Record Tools to Improve the ... Researchers will compare the treatment and outcomes of patients whose clinicians did not receive a BPA, to those whose clinicians received a non-interruptive ...

5. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC7190391/

Noninterruptive Clinical Decision Support Decreases ... Conclusion Noninterruptive CDS interventions are effective in reducing unnecessary and expensive testing, and avoid typical pitfalls such as alert fatigue.

6. withpower.com withpower.com/trial/phase-bronchiolitis-4-2025-3ea53

Electronic Health Record Tools for Bronchiolitis Trial Overview The study tests if best practice advisories (BPAs) in electronic health records help doctors follow guidelines for treating bronchiolitis. It ...

7. journals.lww.com journals.lww.com/pqs/fulltext/2024/01000/impact_of_a_bronchiolitis_clinical_pathway_on.3.aspx

Impact of a Bronchiolitis Clinical Pathway on Management... We performed an interrupted time series (ITS) analysis to assess our primary and secondary outcomes. 21 We estimated a series of logistic regression models ...