Technology Mediated Translation Clinical Decision Support. Marisa L. Wilson, DNSc, MHSc, CPHIMS, RN-BC. January 23, 2015.

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1 Technology Mediated Translation Clinical Decision Support Marisa L. Wilson, DNSc, MHSc, CPHIMS, RN-BC January 23, 2015 Background Presidents Bush, President Obama American Recovery and Reinvestment Act of 2009 Health Information Technology for Economic and Clinical Health Act (HITECH) requires the National Coordinator for Information Technology to drive this endeavor along with other appropriate federal agencies Centers for Medicare and Medicaid Services (CMS) launched EHR Incentive Program 1

2 Hospital EHR Adoption Hospitals Receiving MU Payments As of June 2014, 92 percent (4,500+) of eligible hospitals received incentive payments from the EHR Incentive Programs. Cumulative Share of Ambulatory Physicians, NPs, and PAs Who Have Received a Payment Providers Receiving MU Payment As of June 2014, 75 percent (403,000+) of the nation s eligible professionals received incentive payments from the EHR Incentive Programs. 2

3 Meaningful Use (MU) HealthIT.gov Tasks in Stages of MU HealthIT.gov 3

4 Effects of Meaningful Use Functionalities on Health Care Quality, Safety and Efficiency, By Study Outcome Result (% of Studies) Based on 493 HIT Evaluation Studies - ONC Health IT Systematic Review - Impact on Efficiency, Quality and Safety Health-IT-Literature-Review-Infographic.php 4

5 Meaningful Use and Clinical Decision Support Resulting In 5

6 AACN CNL Informatics Essentials Essential 5: CNL Competencies 1. Analyze current and emerging technologies to support safe practice environments, and to optimize patient safety, costeffectiveness, and health outcomes. 2. Evaluate outcome data using current communication technologies, information systems, and statistical principles to develop strategies to reduce risks and improve health outcomes. 3. Promote policies that incorporate ethical principles and standards for the use of health and information technologies. 4. Provide oversight and guidance in the integration of technologies to document patient care and improve patient outcomes. 5. Use information and communication technologies, resources, and principles of learning to teach patients and others. 6. Use current and emerging technologies in the care environment to support lifelong learning for self and others. AACN CNL Essentials (cont) Use information technology, analytics, and evaluation methods to: collect or access appropriate and accurate data to generate evidence for nursing practice; provide input in the design of databases that generate meaningful evidence for practice; collaborate to analyze data from practice and system performance; design evidence-based interventions in collaboration with the health professional team; examine patterns of behavior and outcomes; and identify gaps in evidence for practice Implement the use of technologies to coordinate and laterally integrate patient care within, across care settings and among healthcare providers. 6

7 AACN CNL Essentials (cont) Analyze current and proposed use of patient-care technologies, including their cost-effectiveness and appropriateness in the design and delivery of care in diverse care settings. Use technologies and information systems to facilitate the collection, analysis, and dissemination of data including clinical, financial and operational outcomes. Use information and communication technologies to document patient care, advance patient education, and enhance accessibility of care. Participate in ongoing evaluation, implementation and integration of healthcare technologies, including the electronic health record (EHR). Use a variety of technology modalities and media to disseminate healthcare information and communicate effectively with diverse audiences. Definition of CDS A tool that provides clinicians, staff, patients or other individuals with knowledge and person-specific information, intelligently filtered or presented at appropriate times, to enhance health and health care. (HealthIT.gov) A strategic tool for actionable knowledge 7

8 Description of CDS Systems Active knowledge systems using patient specific data to generate case specific advice. Use evidence based practice findings and applies that to the patient. Provide quality judgment based on economic and cultural values. Implemented with stakeholders and are led by champions. CDS Tool Examples Computerized alerts Reminders to care providers and patients Clinical guidelines Condition specific order sets Focused data reports and summaries Dashboards Documentation templates Diagnostic support Contextually relevant reference information 8

9 How does CDS Happen During data entry documentation, order sets, care plans During data review single patient summaries, multi patient displays, predictive analytics During assessment filtered reference material or knowledge resources Not During a Task alerts triggering asynchronously (ex: lab results) What Are the Purposes? Assists in problem solving Supports but does not replace clinical judgment and reasoning Improved the decision making process 9

10 Why CDS? Increased quality of care Enhanced outcomes Avoidance of errors and adverse events Improved efficiency Cost effectiveness Provider and patient satisfaction How Does CDS Work? CDS processes require: Actionable evidence Embedded and accurate person specific data Technical reasoning mechanisms that combine evidence based knowledge and data to form information that can be acted upon A method to filter and display information that supports workflows Enough information to allow for quick decision making 10

11 The CDS Five Rights Rights information Right person Right intervention Right channel Right point in the workflow CDS Model 11

12 The Informatics Model Behind CDS Alignment with Underpinnings of Informatics 12

13 How are CDS Systems Created? Systems Development Life Cycle 13

14 Planning Tasks Aligning the mission, vision and values of the organization Defining the Problem Developing the Scope Review of the literature Determining feasibility (technical, schedule, financial) Producing a draft project plan Defining an initial team Present return on investment The Analysis Tasks Analyzing the existing system Synthesis of evidence Exploring the human factors Developing a workflow as is and to be Conducting Business Process Redesign Crafting Prototypes or a Use Case Drafting requirements Establishing requirements (including equipment) Develop evaluation strategy Review current Policies and Procedures 14

15 Tools Used in Analysis A Workflow Diagram A graphical depiction of steps taken, time spent, distance traveled necessary to complete a required business process. 15

16 Workflow Diagram Data Flow Diagram A data flow diagram (DFD) is a graphical representation of the "flow" of data through an information system. 16

17 Data Flow Diagram A Use Case Diagram Use Case Diagrams graphically depict: -The actors that the system you are describing interacts, -The system itself, -The use cases, or services, that the system knows how to perform, -The lines that represent relationships between these elements. 17

18 A Use Case Diagram The Design Tasks Define the input requirements This includes standardized terminology, tools, and measures Define the output requirements Develop system controls Determine interface needs Create security protocols Draft downtime and disaster recovery processes 18

19 The Implementation Tasks Develop and begin training Prepare equipment Ensure that Policies and Procedures are up to date Review system s User Manuals Educate support and Help Desk The Maintenance Tasks Determine evaluation outcomes Analyze processes for work arounds Activate strategy for ensuring the evidence driving the CDS action is up to date Develop process for change control 19

20 The Promise of CDS Improved healthcare quality, safety, and cost efficiency Achievement of unit goals Engagement of evidence Provision of best practice Prevention of adverse events Appropriate resource utilization The Perils of CDS Poor acceptance and untoward consequences Poorly designed interventions that create distraction Overuse and reliance on CDS and lack of use of clinical judgment Inadequate planning, analysis and development leading to lack of use No quality management of the CDS 20

21 Resources What is Clinical Decision Support (CDS)? Clinical Decision Support Systems: State of the Art Types of Clinical Decision Support: Examples from HIMSS Davies Award Winners Clinical Decision Support 21

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