Clinical Decision Support for Hyperbilirubinemia Risk Assessment in the Electronic Health Record

John D. Petersen, Margaret Lozovatsky, Daniela Markovic, Ray Duncan, Simon Zheng, Arash Shamsian, Sonya Kagele, Mindy K. Ross

Research output: Contribution to journalArticlepeer-review

3 Scopus citations


Background: Physiologic neonatal hyperbilirubinemia (jaundice) is common and affects most newborn infants. However, there is a risk for permanent neurological damage if the bilirubin levels rise above a certain threshold. The management of neonatal jaundice includes the assessment of bilirubin laboratory values, consideration of patient-specific risk factors, and plotting on a bilirubin nomogram reference to determine risk and guide therapy. When performed manually, the process can be time consuming and error-prone. Therefore, web-based calculators such as BiliTool have been developed to assist in risk assessment. Methods: To streamline the risk assessment calculation process further within our electronic health record (EHR), we created a “BiliReport” to display patient bilirubin-related data and automate transmission of deidentified patient data to the BiliTool website ( After implementation, we evaluated usage data, provider satisfaction, and accuracy of documentation. Results: We demonstrated high provider use of the BiliReport and satisfaction with the workflow. We found a significant improvement in the accuracy of bilirubin risk level documentation, with a reduction in erroneous risk stratification from 4% (15/232) to 0.4% (1/243), P < 0.001. We did not find significant a difference in erroneous documentation of the bilirubin lab value (P = 0.07). Conclusions: Integrating the neonatal hyperbilirubinemia risk assessment process into the EHR may reduce errors and improve provider documentation and adherence to recommended guidelines.

Original languageEnglish
Pages (from-to)857-862
Number of pages6
JournalAcademic Pediatrics
Issue number6
StatePublished - Aug 2020


  • clinical decision support
  • electronic health record
  • neonatal hyperbilirubinemia


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