{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,10]],"date-time":"2026-02-10T20:51:59Z","timestamp":1770756719912,"version":"3.50.0"},"reference-count":13,"publisher":"Georg Thieme Verlag KG","issue":"04","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Appl Clin Inform"],"published-print":{"date-parts":[[2025,8]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Retinopathy of prematurity (ROP) is the leading cause of preventable childhood blindness. Guidelines recommend screening for infants with gestational age at birth &lt;31 weeks or birth weight \u22641,500\u2009g. However, ensuring timely screening during readmissions after birth is challenging.<\/jats:p><jats:p>To analyze the performance of an interruptive alert at a large academic pediatric hospital for identifying premature infants needing ROP screening upon hospital readmission and to describe how data informed the transition to a non-interruptive dashboard.<\/jats:p><jats:p>The alert appeared for patients 1 to 365 days of age hospitalized in acute care or pediatric intensive care and instructed providers to order an ophthalmology consult from within the alert and to call ophthalmology for at-risk patients. For quality improvement, the clinical decision support (CDS) advisory group evaluated the effectiveness and efficiency of the alert. We extracted alert metrics from the hospital's enterprise data warehouse, including the user response and feedback, patient characteristics (age, birth gestational age, and birth weight), and any ophthalmology consultations. We analyzed the percentage of encounters seen by ophthalmology using a statistical process control chart during alert implementation and 6 months before and after.<\/jats:p><jats:p>The alert appeared 3,309 times during 2,194 patient encounters usually. Users chose \u201cAccept and place order\u201d for 43% (943\/2,194) of encounters, but only 11% (102\/943) had an ophthalmology consult; 34% (53\/155) of ophthalmology consultations occurred in encounters with a final response other than \u201cAccept and place order.\u201d The intervention was redesigned using a non-interruptive surveillance dashboard with greater specificity, and the alert was de-implemented.<\/jats:p><jats:p>Analysis of a failed interruptive alert for identifying patients at risk for ROP led to a transition to targeted surveillance using a dashboard. This case emphasizes the importance of aligning the CDS modality to the clinical workflow, information availability, and user decision-making needs and should be supported by governance.<\/jats:p>","DOI":"10.1055\/a-2594-3571","type":"journal-article","created":{"date-parts":[[2025,4,25]],"date-time":"2025-04-25T19:33:53Z","timestamp":1745609633000},"page":"1024-1030","source":"Crossref","is-referenced-by-count":2,"title":["Redesigning Clinical Decision Support for Retinopathy of Prematurity Screening After Alert Failure"],"prefix":"10.1055","volume":"16","author":[{"given":"Mikael C.","family":"Guzman-Karlsson","sequence":"additional","affiliation":[{"name":"Texas Children's Hospital, Houston, Texas, United States"},{"name":"Division of Pediatric Neurology and Developmental Neuroscience, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, United States"},{"name":"Division of Informatics, Department of Pathology and Immunology, Baylor College of Medicine, Houston, Texas, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lauren M.","family":"Hess","sequence":"additional","affiliation":[{"name":"Texas Children's Hospital, Houston, Texas, United States"},{"name":"Division of Pediatric Hospital Medicine, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Amy L.","family":"Jeppesen","sequence":"additional","affiliation":[{"name":"Texas Children's Hospital, Houston, Texas, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Regine M.","family":"Fortunov","sequence":"additional","affiliation":[{"name":"Texas Children's Hospital, Houston, Texas, United States"},{"name":"Division of Neonatology, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"194","published-online":{"date-parts":[[2025,9,5]]},"reference":[{"issue":"06","key":"ref1","doi-asserted-by":"crossref","first-page":"e20183061","DOI":"10.1542\/peds.2018-3061","article-title":"Screening examination of premature infants for retinopathy of prematurity","volume":"142","author":"W M Fierson","year":"2018","journal-title":"Pediatrics"},{"key":"ref2","doi-asserted-by":"crossref","DOI":"10.4324\/9781498757461","volume-title":"Improving Outcomes with Clinical Decision Support. 2nd ed","author":"A Osheroff Jerome","year":"2012"},{"key":"ref3","volume-title":"Clinical Decision Support Systems: Theory and Practice. 3rd ed","author":"E S Berner","year":"2016"},{"issue":"06","key":"ref4","doi-asserted-by":"crossref","first-page":"523","DOI":"10.1197\/jamia.M1370","article-title":"Ten commandments for effective clinical decision support: making the practice of evidence-based medicine a 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Chaparro","year":"2022","journal-title":"Appl Clin Inform"},{"issue":"18","key":"ref9","doi-asserted-by":"crossref","first-page":"e035529","DOI":"10.1161\/JAHA.124.035529","article-title":"Smaller left ventricular size but preserved function in adolescents and adults born preterm","volume":"13","author":"G P Barton","year":"2024","journal-title":"J Am Heart Assoc"},{"issue":"02","key":"ref10","doi-asserted-by":"crossref","first-page":"e12469","DOI":"10.2196\/12469","article-title":"Interruptive versus noninterruptive clinical decision support: usability study","volume":"6","author":"S Blecker","year":"2019","journal-title":"JMIR Hum Factors"},{"issue":"08","key":"ref11","doi-asserted-by":"crossref","first-page":"e2400478","DOI":"10.1200\/PO-24-00478","article-title":"Expert-guided large language models for clinical decision support in precision oncology","volume":"8","author":"J Lammert","year":"2024","journal-title":"JCO Precis Oncol"},{"issue":"09","key":"ref12","doi-asserted-by":"crossref","first-page":"1812","DOI":"10.1093\/jamia\/ocad259","article-title":"Improving large language models for clinical named entity recognition via prompt engineering","volume":"31","author":"Y Hu","year":"2024","journal-title":"J Am Med Inform Assoc"},{"issue":"02","key":"ref13","doi-asserted-by":"crossref","first-page":"187","DOI":"10.1136\/jamia.2009.002030","article-title":"Governance for clinical decision support: case studies and recommended practices from leading institutions","volume":"18","author":"A Wright","year":"2011","journal-title":"J Am Med Inform Assoc"},{"issue":"01","key":"ref14","doi-asserted-by":"crossref","first-page":"177","DOI":"10.1093\/jamia\/ocaa279","article-title":"Optimizing clinical decision support alerts in electronic medical records: a systematic review of reported strategies adopted by hospitals","volume":"28","author":"B A Van Dort","year":"2021","journal-title":"J Am Med Inform Assoc"}],"container-title":["Applied Clinical Informatics"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/a-2594-3571.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,5]],"date-time":"2025-09-05T23:18:57Z","timestamp":1757114337000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/a-2594-3571"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,4,25]]},"references-count":13,"journal-issue":{"issue":"04","published-online":{"date-parts":[[2025,8,6]]},"published-print":{"date-parts":[[2025,8]]}},"URL":"https:\/\/doi.org\/10.1055\/a-2594-3571","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["1869-0327"],"issn-type":[{"value":"1869-0327","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2025,4,25]]},"published":{"date-parts":[[2025,4,25]]}}}