week 5 Informatics
Ldominguez03
2 years ago
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files (2)Week5Informaticsdiscussion.docx
9780826167583_PPTX_CH19.pptx
Week5Informaticsdiscussion.docx
Characteristics and Elements of a Successful Clinical Decision Support Team
Builders should understand:
· The clinical relevance of the care that CDS addresses and
· Relevant workflows and processes.
Disconnects occurring due to the language barrier in understanding healthcare-specific terminology must be eliminated.
The end user must experience a seamless and unobtrusive process.
Frameworks for Success
The “10 commandments” for success framework includes:
· Recommendations on timeliness, end-user needs, addressing resistance,
· Simplicity, monitoring impact, and managing the system based on the evidence
CDS encompasses a wide variety of tools such as:
· Computerized alerts, drug-drug interaction alerts, under-dose or overdose alerts,
· Actionable clinical guidelines, condition-specific order sets, and focused patient data reports.
Population-specific data, for example, micro-biograms, which are tables of local bacterial flora and their sensitivity and susceptibility to various antibiotics, can be used for CDS.
Federal agencies such as Office of the National Coordinator (ONC) and the Agency for Healthcare Research and Quality (AHRQ) mainI) could be used to:
· Leverage the information and
· Either pull the information on-demand or download information on a routine basis.
Considering the four case studies presented, let us outline the life cycle intervention for each of the programs and consider the following question:
In examining the four case studies [chapter 19], Which interventions were most effective,the and how effective were they? Support your position with evaluation measures noted in each of the case studies. Are they qualitative or quantitative approaches? Could the team have improved its evaluation strategies? If so, how? If not, why not?
For your reference:
Chapter 19 explains the clinical decision support (CDS) programs and states the five rights frameworks that aid in its accomplishment. CDS is described as a set of tools to develop decision-making in the clinical workflow encompassing advanced methodologies such as predictive analytics, prescriptive analytics, and structured methodologies for promoting interoperability programs and improving cardiovascular health outcomes.
The challenges and complications associated with inappropriate usage of CDS that may lead to potential patient safety and legal implications for organizations raise the need to design CDS strategies to improve interventions and patient outcomes. The importance of including departments that support optimizing the overall impact of the CDS intervention on patient safety and quality has been emphasized and reviewed with important steps and concerns with liability for clinicians and hospitals.
We will be discussing several case studies that provide strategies for bringing specific CDS performance improvement into organizations that have also been stated.
· CDS is an effective tool for improving adherence to clinical initiatives such as deep vein thrombosis (DVT)prophylaxis, cardiac mortality prevention strategies outlined in the Million Hearts campaign, and areas associated with the regulatory reporting requirements of quality measures.
· The five rights address the who, what, where, when, and how of a CDS program while emphasizing the importance of clear articulation of goals and objectives that identify all five components.
· The National Library of Medicine (NLM)maintains the Value Set Authority Center (VSAC) repository and includes clinical vocabularies such as SNOMed, RxNorm, and Loinc.
· The Office of the National Coordinator (ONC) and the MITRE corporation shift content from narrative to structure in an attempt to keep CDS evidence-based.
· The Institute of Medicine (IOM)report Health IT and Patient Safety: Building Safer Systems for Better Care outlines several relevant recommendations as to what constitutes safety from an end-user standpoint.
Please remember for discussion posts: the initial post must be uploaded by the WEDNESDAY of the week and two replies to your peers by Saturday at 2359.
Please note the grading rubric for the discussion board.
As a reminder, all discussion posts must be a minimum of 350 words initial and 250 words peer responses, references must be cited in APA format 7th Edition, and must include a minimum of 2 scholarly resources published within the past 5 years.
9780826167583_PPTX_CH19.pptx
CHAPTER 19
Clinical Decision Support Systems
INTRODUCTION
Clinical decision support (CDS) provides person-specific information to enhance decision-making in health and healthcare.
CDS is a key strategy within the federal Health Information Technology for Economic and Clinical Health (HITECH) Act to:
Promote interoperability program (PIP) of electronic health records (EHRs).
CDS improves adherence to clinical initiatives outlined:
In the Million Hearts campaign and
Areas associated with the regulatory reporting requirements of quality measures.
Inappropriate use of CDS results in:
Potential patient safety and
Legal implications for organizations.
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THE BASICS OF CLINICAL DECISION SUPPORT
Historical examples of CDS tools include:
practice guidelines, patient cards, and
tables of important medical knowledge.
ClinfoWiki housed by the Oregon Health & Science University is a website for biomedical informatics.
An effectively deployed CDS integrates into clinical workflow.
To increase the magnitude of impact on patient care.
The five rights of CDS may be used as a checklist before deploying a solution.
Certain formats of CDS tools include:
“Hard-stop” best practice alerts (BPAs), passive alerts,
Information sections, and links to source documents.
Usability testing by end users is the gold standard.
To ensure effective use of CDS tools for desired clinical outcomes.
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THE BASICS OF CLINICAL DECISION SUPPORT
As a best practice, end users should be provided with multiple avenues of feedback.
such as email addresses, phone numbers, and committee meetings
Clinical Decision Support: Definitions, Goals, and Objectives
CDS helps make clinical decisions easier.
It offers evidence-based choices determined by:
Practice standards, regulatory compliance elements, current literature, and other determinants.
Two tools available to CDS teams are predictive analytics and prescriptive analytics.
Clinical Decision Support: Importance of Human Factors Design Principles
Human factors design takes into account basic principles.
The knowledge about human capabilities and limitations are applied to:
The design of products, processes, systems, and work environments.
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STRATEGIES FOR IMPLEMENTING A SUCCESSFUL CLINICAL DECISION SUPPORT PROGRAM
A successful CDS implementation requires a balance among people, processes, and technology.
Characteristics and Elements of a Successful Clinical Decision Support Team
Builders should understand:
The clinical relevance of the care that CDS addresses and
Relevant workflows and processes.
Disconnects occurring due to the language barrier in understanding healthcare-specific terminology must be eliminated.
The end user must experience a seamless and unobtrusive process.
Frameworks for Success
The “10 commandments” for success framework includes:
Recommendations on timeliness, end-user needs, addressing resistance,
Simplicity, monitoring impact, and managing the system based on the evidence.
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TOOLS AND TYPES OF CLINICAL DECISION SUPPORT
CDS encompasses a wide variety of tools such as:
Computerized alerts, drug–drug interaction alerts, under-dose or overdose alerts,
Actionable clinical guidelines, condition-specific order sets, and focused patient data reports.
Population-specific data, for example, micro-biograms, which are tables of local bacterial flora and their sensitivity and susceptibility to various antibiotics, can be used for CDS.
Federal agencies such as Office of the National Coordinator (ONC) and Agency for Healthcare Research and Quality (AHRQ) maintain CDC repositories.
Clinical quality language (CQL) is easy to read and understand language.
It is used for content items referred to as “artifacts.”
Exclusion criteria would include items such as active pregnancy and impaired glucose tolerance.
Application programming interface (API) could be used to:
Leverage the information and
Either pull the information on-demand or download information on a routine basis.
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USE OF CLINICAL DECISION SUPPORT TO ALIGN IMPROVEMENT INITIATIVES
Clinical champions serve as change agents, represent their groups in:
Reviewing design, prioritizing projects, and
Effectively communicating to clinician groups impacted by the changes.
Clinical Decision Support Oversight Committee
The CDS oversight committee owns and manages decision support workflows and functions.
Deployment of Clinical Decision Support Interventions
The design phase of the intervention should be validated with all stakeholders.
Who will be impacted by the process.
Evaluating and measuring the impact following the cycle of improvement is a critical step.
Measuring the Success of the Program
CDS program evaluation can include both quantitative and qualitative methods.
Organizations that design CDS strategies should align the program with measurement.
To improve pay-for-performance programs and accreditation requirements.
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PROMOTING INTEROPERABILITY PROGRAMS AND CLINICAL DECISION SUPPORT PROGRAMS
PIP was developed as an incentive and compliance program.
To advance the adoption and optimization of the EHR.
Improving Population Health Using Healthcare Information Technology and Clinical Decision Support Strategies
The Million Hearts campaign is a national strategy.
Aims to improve cardiovascular (CV) health by applying CDS strategies.
Aims to:
Reduce the number of people who need treatment,
Optimize treatment and realize the full value of prevention in CV health.
Based on four tenets (ABCS):
A = aspirin use for secondary prevention
B = blood pressure
C = cholesterol control
S = smoking cessation
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CHALLENGES AND ISSUES WITH CLINICAL DECISION SUPPORT
Certification bodies to test and certify EHRs that involve CDS functionality require a significant strategy and infrastructure.
Challenges to Implementing Clinical Decision Support
Challenges associated with implementing CDS are noted in the report by AHRQ.
Providers need alerts on preventive services.
But disagree on the timing of when to receive the alerts within their workflow.
Issues stated in the report are speed and ease of access to alerts.
The issue also states autonomy desired by clinicians on how much control end users have over their response to the CDS.
Timeliness of documentation is important to give critical alerts to clinicians.
For an early warning system such as the Modified Early Warning Score (MEWS), the documentation must be timely.
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FEATURES OF SAFE HEALTHCARE INFORMATION TECHNOLOGY TO ADDRESS CHALLENGES
CDS development should align with the Institute of Medicine (IOM) recommendations.
To help design safe and effective systems.
National Institute for Standards and Technology address design strategies for:
Usability design, and testing guidelines related to usability and patient safety.
Legal Implications
A strong government regulation of CDS and international practice guidelines will reduce liability.
Clinicians are held to the same level of accountability with the EHR as with the paper-based record.
Medical information databases, EHRs, and associated medical expert systems and CDS impacts medical malpractice.
A well-designed CDS system should:
Provide clinically relevant alerts.
Reduce the likelihood of alert fatigue.
Allow clinicians to detect adverse events.
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SUMMARY
This chapter describes the basics of CDS definitions and types of CDS tools for:
Improving user experience and
Encouraging evidence-based care by frontline clinicians.
CDS includes predictive analytics and prescriptive analytics to improve outcomes.
The five rights of CDS comprise leadership, executive support, and interprofessional teams representing the stakeholders most impacted by changes to workflow.
CDS strategies can be optimized using recommendations on:
Timeliness, end-user needs, addressing resistance,
Simplicity, monitoring impact, and managing the system based on the evidence.
The design phase and life cycle of the intervention were reviewed with important steps.
These concerned all stakeholders impacted by the process.
Challenges associated with implementing CDS, safe healthcare technology guidelines, liability for clinicians and hospitals, and legal Implications are discussed.
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