Comparison of diagnostic decision pathway with MDCalc and PE-Dx CDS
| MDCalc (web-based CDS) | PE-Dx CDS | |
| Integration with EHR | ||
| Not integrated in EHR; separate website | Integrated in EHR | |
| Wells’ score (seven criteria) | ||
| Initiation | User needs to open browser, type MDCalc PE in search engine in browser and click on URL for MDCalc website | User clicks on PE-Dx button in ED Navigator |
| Criteria responses | User does not have to answer all (7) criteria before obtaining a score | User has to address all (7) criteria before obtaining the Wells’ score |
| Auto-population | No criteria are auto-populated; therefore, the user may need to navigate between the EHR and MDCalc to search for relevant information | One criterion (heart rate >100) is auto-populated; user may need to navigate within the EHR to search for other relevant information |
| PERC rule (eight criteria) | ||
| Initiation | User must access a different website within MDCalc to review PERC criteria | PERC is integrated in CDS and becomes active when indicated per hospital policy |
| Criteria responses | User must respond yes to only one criterion to receive PERC-positive result | User must respond yes to only one criterion to receive PERC-positive result |
| Auto-population | Does not auto-populate, nor copy results from Wells’ criteria. Therefore, user may need to navigate between the EHR and MDCalc to search for relevant information | Auto-populates three questions (age, heart rate, O2 saturation) and copies forward responses from comparable Wells’ criteria (prior PE or deep vein thrombosis, hemoptysis). Therefore, user must address only three criteria (recent trauma or surgery, exogenous oestrogen, unilateral leg swelling) |
| Risk assessment and decision-making | ||
| Result/score | Provides the user with a score (eg, 3.0 points for Wells’ score) and compares that score with the population (eg, moderate-risk group: 16.2% chance of PE in ED population) | Provides the user with a score |
| Recommendations/next steps | Provides the user with suggestion for next steps; suggestion uses two different models, which can be confusing | Provides the user with a single recommendation in accord with hospital policy and established guidelines49 |
| Order * | Does not automatically provide option to enter an order | Provides the option to go to CPOE to order D-dimer or CTA scan when applicable |
| Documentation * | Allows user to copy results (summary and scores on individual questions) into an EHR note, but user must register to use the feature | Allows the user to populate the results and recommendation directly into his/her note |
*The automated creation of an order and documentation of the decision were not tested in this study, but are available in the implemented version of PE-Dx CDS.
CPOE, computerized provider order entry; CTA, CT angiography; ED, emergency department; PE, pulmonary embolism; PE-Dx CDS, clinical decision support for pulmonary embolism diagnosis; PERC, pulmonary embolism rule-out criteria.