Centralized Electronic Health Record (EHR)-Based Recruitment Workflow for the Diuretic Comparison Project (DCP)
The architectural features that distinguished our model from other systems were its adaptability and stability, as partitioned into 3 electronic workflows (primary care clinician [PCC] consent, patient consent, and patient randomization). This is accordingly delineated in the top-down, tree-like flow of this diagram. Blue boxes indicate a process embedded in the VA Cooperative Data Warehouse (CDW); beige, research data captured in the web-based software used to customize data collection; orange, tasks managed by study nurses through computerized patient record system; dark gray, creation of study database; and light gray, standard trial procedures to enroll PCCs and patients.Patients managed by the consented PCCs were then identified and assessed for study eligibility. Contact information of eligible patients were loaded into the web application. A mailing timestamp was generated after an informational letter was sent, which marked the 14 days opt-out period. If an opt-out timestamp was absent, each patient’s telephone information was loaded into the application for the central calling centers. Call attempts and consent status were documented. Corresponding consent records were transferred to the SQL study database, which triggered the randomization workflow among consented patients.Study randomization approval obtained from PCC were documented in patient’s EHR. A daily tracking of the specific EHR data (PCC’s electronic approval) was automated by applying a real-time signature alert. A predefined order entry was used when requesting PCC approval. The digital approval was detected with a string-matching algorithm. This technique also was used to search PCC approval for hydrochlorothiazide discontinuation and chlorthalidone prescription.