dissertationFollowing liver transplantation, patients require lifelong immunosuppressive care and monitoring to prevent organ rejection, drug toxicity, and death. Traditionally, transplant centers use paper-based processes that are not scalable and can lead to inefficiencies and deficiencies in information management. Clinical decision support (CDS) tools may help to overcome information management challenges, and a system-agnostic approach may help to disseminate these tools nationwide. We sought to inform the development of new transplant information systems by analyzing existing information systems. To meet this overall objective, we administered a survey and found that all liver transplant programs used manual, paper-based processes and nearly all used electronic health record (EHR) systems. Programs also had immunosuppression guidelines with similar logic patterns. Then we analyzed long-term use of a computerized notification system at one transplant center and found that a system designed specifically for the posttransplant workflow can meet long-term information management needs. Next, we assessed the clinical outcomes associated with computerized notifications for laboratory monitoring of immunosuppressive care and found that a system designed specifically for the posttransplant workflow was associated with improved clinical outcomes. Following this, we described workflow processes at two transplant centers and found that a transplant-specific notification system was associated with changes in workflow process iv measures and the satisfaction of performing laboratory monitoring tasks compared to a general EHR notification system. Finally, we administered a questionnaire to coordinators using a transplant-specific notification system and identified the usage of specific data elements in computerized notifications for posttransplant laboratory monitoring. Our findings show that near universal use of EHRs provides an infrastructure for implementing CDS tools, and logic patterns for posttransplant laboratory monitoring can be generalized to other U.S. transplant centers. Transplant-specific computerized notifications may be part of a system of processes that improve the scalability, quality, and satisfaction of patient management by postliver transplant coordinators. However, these systems must be flexible enough to accommodate new immunosuppressants and changing or additional parameters used in computerized logic as clinical practice or needs of the patient population evolve. Proactive notifications sent directly to patients regarding upcoming due dates via patient portals may also improve patient outcomes
