# Development of SMART on FHIR interoperable clinical decision support for emergency department patients with pneumonia and pilot deployment into novel Epic electronic health record environments

> **NIH AHRQ R18** · IHC HEALTH SERVICES, INC. · 2024 · $1,000,000

## Abstract

Project Summary
In the United States, more than 1.5 million adults are hospitalized each year with community-acquired
pneumonia. Despite availability of high-quality guidelines for the treatment of patients with pneumonia,
guideline adherence remains poor and patient care is variable. Lack of objective risk assessment leads to
unnecessary hospital admissions and misallocation of scarce intensive care resources. Thus, there is a
critical need for well-designed clinical decision support (CDS) tools to assist clinicians with accurate
diagnosis and appropriate treatment for patients with pneumonia. Intermountain Healthcare developed
and deployed real-time electronic CDS (called ePNa) embedded in the Cerner electronic health record
(EHR) across 20 adult hospital emergency departments. ePNa gathers real- time and historical data from
the EHR combined with artificial intelligence processing of chest images (ChexED) to guide pneumonia
diagnosis, risk stratification, site of care, risk of antibiotic resistance, and treatment. ePNa smooths
transitions of care between clinicians. Our work incorporates the Five Rights of CDS to optimize the
technology’s strengths in the clinical environment. Two controlled studies demonstrate that ePNa
increases guideline-recommended, best practice care and decreases 30-day all-cause mortality in adults
with pneumonia. ePNa is ready to be deployed to additional environments with distinct patient
populations and EHRs. However, siloed EHRs limit technology developed within one vendor from being
shared with others. The objective of this proposal is to enable broad dissemination of ePNa by
optimizing its interoperability, scalability, and usability. Accordingly, we aim to (1) Develop a SMART on
FHIR ePNa application capable of interfacing with both the Cerner and Epic EMRs and conduct a
formative evaluation through an iterative design process. We will rapidly refine and validate the new
ePNa application. (2) Engage patients and clinicians to inform the patient-centeredness of ePNa’s clinical
interface. The project will incorporate feedback from stakeholder clinicians, administrators, and patients
to understand contextual factors affecting implementation success in a novel geographic and
demographic environment. (3) Evaluate the feasibility and acceptability of ePNa through a pilot
implementation trial guided by the RE-AIM QuEST framework.
Our proposal is likely to facilitate guideline adherent care for patients with pneumonia broadly across
different healthcare systems.

## Key facts

- **NIH application ID:** 10894047
- **Project number:** 5R18HS028955-02
- **Recipient organization:** IHC HEALTH SERVICES, INC.
- **Principal Investigator:** NATHAN C DEAN
- **Activity code:** R18 (R01, R21, SBIR, etc.)
- **Funding institute:** AHRQ
- **Fiscal year:** 2024
- **Award amount:** $1,000,000
- **Award type:** 5
- **Project period:** 2023-08-01 → 2026-07-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10894047

## Citation

> US National Institutes of Health, RePORTER application 10894047, Development of SMART on FHIR interoperable clinical decision support for emergency department patients with pneumonia and pilot deployment into novel Epic electronic health record environments (5R18HS028955-02). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/10894047. Licensed CC0.

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