title: Checklist for Early Recognition and Treatment of Acute Illness (CERTAIN): evolution of a content management system for point-of-care clinical decision support.
abstract: The Checklist for Early Recognition and Treatment of Acute Illness (CERTAIN) is an international collaborative project with the overall objective of standardizing the approach to the evaluation and treatment of critically ill patients world-wide, in accordance with best-practice principles. One of CERTAIN's key features is clinical decision support providing point-of-care information about common acute illness syndromes, procedures, and medications in an index card format.
  
  
  
  This paper describes 1) the process of developing and validating the content for point-of-care decision support, and 2) the content management system that facilitates frequent peer-review and allows rapid updates of content across different platforms (CERTAIN software, mobile apps, pdf-booklet) and different languages.
  
  
  
  Content was created based on survey results of acute care providers and validated using an open peer-review process. Over a 3 year period, CERTAIN content expanded to include 67 syndrome cards, 30 procedure cards, and 117 medication cards. 127 (59 %) cards have been peer-reviewed so far. Initially MS Word® and Dropbox® were used to create, store, and share content for peer-review. Recently Google Docs® was used to make the peer-review process more efficient. However, neither of these approaches met our security requirements nor has the capacity to instantly update the different CERTAIN platforms.
  
  
  
  Although we were able to successfully develop and validate a large inventory of clinical decision support cards in a short period of time, commercially available software solutions for content management are suboptimal. Novel custom solutions are necessary for efficient global point of care content system management.
authors.affiliation: Multidisciplinary Epidemiology and Translational Research in Intensive Care (M.E.T.R.I.C.), Division of Pulmonary and Critical Care Medicine, Mayo Clinic, 200 1ST Street SW, Rochester, MN, USA. barwise.amelia@mayo.edu.
authors.forename: Amelia
authors.initials: A
authors.lastname: Barwise
authors.affiliation: Multidisciplinary Epidemiology and Translational Research in Intensive Care (M.E.T.R.I.C.), Division of Pulmonary and Critical Care Medicine, Mayo Clinic, 200 1ST Street SW, Rochester, MN, USA.
authors.forename: Lisbeth
authors.initials: L
authors.lastname: Garcia-Arguello
authors.affiliation: Multidisciplinary Epidemiology and Translational Research in Intensive Care (M.E.T.R.I.C.), Division of Pulmonary and Critical Care Medicine, Mayo Clinic, 200 1ST Street SW, Rochester, MN, USA.
authors.forename: Yue
authors.initials: Y
authors.lastname: Dong
authors.affiliation: Multidisciplinary Epidemiology and Translational Research in Intensive Care (M.E.T.R.I.C.), Division of Pulmonary and Critical Care Medicine, Mayo Clinic, 200 1ST Street SW, Rochester, MN, USA.
authors.forename: Manasi
authors.initials: M
authors.lastname: Hulyalkar
authors.affiliation: The Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia.
authors.forename: Marija
authors.initials: M
authors.lastname: Vukoja
authors.affiliation: Academisch Medisch Centrum, Universiteit van Amsterdam, Amsterdam, Netherlands.
authors.forename: Marcus J
authors.initials: MJ
authors.lastname: Schultz
authors.affiliation: Department of Critical Care Medicine, Sunnybrook Health Sciences Centre and University of Toronto, Toronto, Canada.
authors.forename: Neill K J
authors.initials: NK
authors.lastname: Adhikari
authors.affiliation: Emergency Department, René Arbeltier Hospital, Coulommiers, France.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Bonneton
authors.affiliation: Department of Anesthesiology and Reanimation, Gulhane Military Medical Faculty, 06010, Etlik, Amkara, Turkey.
authors.forename: Oguz
authors.initials: O
authors.lastname: Kilickaya
authors.affiliation: Multidisciplinary Epidemiology and Translational Research in Intensive Care (M.E.T.R.I.C.), Division of Pulmonary and Critical Care Medicine, Mayo Clinic, 200 1ST Street SW, Rochester, MN, USA.
authors.forename: Rahul
authors.initials: R
authors.lastname: Kashyap
authors.affiliation: Multidisciplinary Epidemiology and Translational Research in Intensive Care (M.E.T.R.I.C.), Division of Pulmonary and Critical Care Medicine, Mayo Clinic, 200 1ST Street SW, Rochester, MN, USA.
authors.forename: Ognjen
authors.initials: O
authors.lastname: Gajic
authors.affiliation: Multidisciplinary Epidemiology and Translational Research in Intensive Care (M.E.T.R.I.C.), Division of Pulmonary and Critical Care Medicine, Mayo Clinic, 200 1ST Street SW, Rochester, MN, USA.|Department of Medicine, Boston Medical Center, Boston University School of Medicine, Boston, MA, USA.
authors.forename: Christopher N
authors.initials: CN
authors.lastname: Schmickl
mesh_terms: D000208:Acute Disease / Q000628:therapy*; D057189:Checklist; D003422:Critical Care / Q000379:methods*; D020000:Decision Support Systems, Clinical; D042241:Early Diagnosis; D006801:Humans; D019095:Point-of-Care Systems
keywords: Checklist; Content; Critical care; Decision-support tool; Infrastructure; Point-of-care; Software; Technology