The California Parkinson’s Disease Registry (CPDR) requires all providers to report date of diagnosis for patients with Parkinson’s disease (PD). We have shown date of diagnosis reporting from a single health system has 33% accuracy. We designed a Clinical Decision Support (CDS) tool to combine symptom screening, a component of quality care for patients with PD, and date of diagnosis prompt.  

We surveyed patients, primary care providers (PCP), and neurologists for content to improve clinical care.  We used an interactive user-centered design process. Final CDS used discrete fields/buttons to prompt/remind users of symptoms to screen, select positive/negative options, allow free text annotation, and auto-create relevant parts of note. We included a prompt to enter a date of diagnosis. Partnership with electronic health record (EHR) vendor standardized discrete elements. Initial release of CDS was accompanied by targeted emails and direct outreach to and by clinical leadership. Usage was assessed through weekly reports from EHR vendor and date of diagnosis reliability was confirmed through chart review.

Over 13 weeks, the tool was activated 16 times.  The tool was used at 7 visits by 6 users (2 movement disorders, 1 general neurologist, and 3 PCP), representing ~0.3% of eligible encounters. In 3 visits the tool documented PD symptoms. In 6 visits the date of diagnosis captured by the CDS indicated an earlier date from what would have been reported to the CPDR.  

Despite design/integration efforts, CDS is challenging to implement, especially for data fields that do not impact clinical care directly. Partnership with EHR vendors can enhance automated interoperability of data elements for registries. Standardization/promotion at a vendor level, CDS enhancements, alignment of incentives and population level aggregation will be needed to improve accuracy of diagnosis dates.