Interdisciplinary Collaboration

 


Nursing meets Technology 

Collaboration

Collaboration between nursing and technology disciplines plays a critical role in refining Clinical DecisionSupport Systems (CDSS) and using of mobile applications. The nursing perspective was aligned with the patient’s current practice and real-time situations. The outcomes have the capability to be user-friendly and evidence-based (Dodson & Layman, 2023). Their interdisciplinary approach between nursing and computer science led to a mobile CDSS that was user-friendly and clinically relevant, bridging the gap between pharmacogenetics and everyday prescribing.

Through the use of developers, the healthcare and patients can collaborate and create a user-friendly, safe patient outcome allowing for a unified system. In order for healthcare to feel comfortable with the use of CDSS, it must be functional and align with understanding, workflow, and professional values (Ackerhans et al., 2024). Involving users while developing apps and receiving constructive feedback identifies barriers and encourages broader use of CDSS in practice.

In the article, “Key Issues for Stakeholder Engagement in the Development of Health and Healthcare Guidelines” (Petkovic et al., 2023) six areas to enhance stakeholder involvement in guideline development to outline plans and develop stakeholder engagement:

  


Furthermore, stakeholder engagement is necessary when integrating technology into clinical practice (Roberston et al., 2022). Electronic health records (EHR) can improve interprofessional collaboration and communication. When EHRs and CDSS are developed with input from healthcare users it encourages user-friendly, offers support and training. CDSS designed with user input and professional feedback can foster a unified, team approach to patient care.



Case Study: Interdisciplinary Design and Implementation of a Clinical Decision Support System for ADHD in Primary Care

Setting: A suburban primary care clinic (Willowbrook Family Health) serving a growing population of school-aged children with behavioral and academic concerns

Challenge: Accurate and timely identification of Attention-Deficit/Hyperactivity Disorder (ADHD) in children, which is often delayed due to inconsistent screening, lack of school coordination, and limited behavioral health integration.

Solution: Develop and implement an interdisciplinary Clinical Decision Support (CDS) system to improve ADHD screening, diagnosis, and follow-up care through a structured, collaborative workflow.

Interdisciplinary Team:

·                        Nurse Practitioners (NPs): Conduct initial assessments, use the CDS tools, and lead                  care coordination.

              Behavioral Health Specialist (LCSW): Evaluate psychosocial factors and provide                       therapy referrals.

  • School Nurse (RN): Ensure adherence to medications daily.

  • Academic Teacher: Inform of effectiveness of medications while at school

  • Clinical Informaticist (RN-BC): Lead CDS design and ensure seamless EHR integration.
  • Child Psychiatrist (Consultant): Provide guidance on diagnostic criteria and treatment planning.

  • School Liaison (Educational Psychologist): Facilitate communication with educators and interpret teacher-reported assessments.

  • Care Coordinator (RN): Monitor follow-up appointments, track treatment adherence, and manage communication.

  • Parent Advocate: Ensure that caregiver perspectives are incorporated into CDS design and family education materials.

CDS System Design and Implementation:

 

  1. Needs Assessment:
    Conducted a thorough review of workflow inefficiencies and delays in ADHD diagnosis. Identified gaps in school-provider communication, underuse of screening tools, and inconsistent follow-up care.
  2. Data Elements:
    Identified essential inputs for CDS functionality:
    • Parent- and teacher-completed Vanderbilt ADHD Rating Scales
    • EHR data on behavioral concerns, academic issues, and family history
    • Risk indicators for differential diagnoses (e.g., trauma, anxiety)
  3. Algorithm Development:
    Developed a tailored CDS algorithm aligned with AAP ADHD guidelines. The system:
    • Flags patients with repeated behavioral concerns
    • Automatically generates and tracks Vanderbilt forms
    • Suggests next steps based on score thresholds
    • Prompts re-evaluation and medication monitoring timelines
  4. EHR Integration:
    Integrated the CDS into the existing EHR, enabling automatic form generation, data tracking, and alerts for follow-up, medication side effects, and treatment milestones.
  5. Training and Education:
    Conducted clinic-wide training on ADHD criteria, CDS usage, school collaboration protocols, and shared decision-making strategies. Co-developed family-facing education materials with input from the parent advocate.

Evaluation:

  • Process Measures:
    • Time from initial concern to diagnosis
    • Completion rates of Vanderbilt forms
    • Follow-up visit compliance
    • Adherence to ADHD guideline-based care
  • Outcome Measures:
    • Functional improvement in patients (school, home, behavior)
    • Reduction in inappropriate stimulant prescribing
    • Parent and teacher satisfaction with care coordination
  • User Feedback:
    • Clinicians reported improved confidence and reduced cognitive load
    • Families felt more engaged in the decision-making process
    • Teachers noted more timely interventions and clearer communication (Fiks et al., 2021)

Results:

  • Improved ADHD Identification:
    The CDS system significantly reduced the time to diagnosis (from 4.5 weeks to 2.7 weeks), with increased use of standardized assessments.
  • Enhanced Interdisciplinary Communication:
    Collaboration between primary care, behavioral health, and schools improved clarity and continuity of care.
  • Better Follow-Up and Medication Monitoring:
    Follow-up compliance rose from 52% to 88%, and alerts helped identify and manage side effects early.
  • Increased Clinician and Parent Satisfaction:
    Providers appreciated the guidance and workflow efficiency, while parents valued inclusion and transparency.

Conclusion:

The implementation of an ADHD-focused CDS system through interdisciplinary collaboration improved diagnostic accuracy, communication with families and schools, and overall workflow in primary care. This case highlights the critical role of team-based design, data-driven decision-making, and shared accountability in developing effective CDS strategies for complex pediatric conditions.


 

References:

Ackerhans S, Huynh T, Kaiser C, Schultz C. (2024). Exploring the role of professional identity in the implementation of clinical decision support systems-a narrative review. Implement Sci. 12;19(1):11. doi: 10.1186/s13012-024-01339-x.

Dodson, C., & Layman, L. (2023). Interdisciplinary collaboration among nursing and computer science to refine a pharmacogenetics clinical decision support tool via mobile application. Computers, Informatics, Nursing, 41(10), 577–583. https://doi.org/10.1097/CIN.0000000000000959

Fiks, A. G., Mayne, S. L., McCarn, B., Power, T. J., Guevara, J. P., & Jimenez, M. E. (2021). Improving care management in attention-deficit/hyperactivity disorder: A randomized controlled trial. Pediatrics, 148(2), e2020031518. https://doi.org/10.1542/peds.2020-031518

Petkovic J, Magwood O, Lytvyn L, Khabsa J, Concannon TW, Welch V, Todhunter-Brown A, Palm ME, Akl EA, Mbuagbaw L, Arayssi T, Avey MT, Marusic A, Morley R, Saginur M, Slingers N, Texeira L, Ben Brahem A, Bhaumik S, Bou Akl I, Crowe S, Dormer L, Ekanem C, Lang E, Kianzad B, Kuchenmüller T, Moja L, Pottie K, Schünemann H, Tugwell P.(2023).Key issues for stakeholder engagement in the development of health and healthcare guidelines. Res Involv Engagem;9(1):27. doi: 10.1186/s40900-023-00433-6. 

Robertson ST, Rosbergen ICM, Burton-Jones A, Grimley RS, Brauer SG. The Effect of the Electronic Health Record on Interprofessional Practice: A Systematic Review. Appl Clin Inform. 2022 May;13(3):541-559. doi: 10.1055/s-0042-1748855.

 




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