GS2. Improving Outcomes with Clinical Decision Support. Session Summary. Session Objectives. References
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1 GS2 Improving Outcomes with Clinical Decision Support Susan Cheeseman, DNP, APRN, NNP-BC Clinical Informatics Analyst St. Lukes Health System, Boise, ID The speaker has signed a disclosure form and indicated she has no significant financial interest or relationship with the companies or the manufacturer(s) of any commercial product and/or service that will be discussed as part of this presentation. Session Summary The seminal Institution of Medicine, To Err is Human: Building a Safer Health System, endorsed Clinical Decision Support (CDS) as one of the most powerful tools available in the national imperative toward improving patient safety and health care quality. CDS is a process for enhancing health care related decisions and actions with pertinent, organized clinical knowledge and patient information to improve health and heath care. In this session, CDS interventions will be explored across the care continuum, providing different kinds of information to different care delivery participants in a variety of formats through different channels into various points in workflow. Session Objectives Upon completion of this presentation, the participant will be able to: define Clinical Decision Support; describe the Five Right of CDS - right information - right people - right intervention - right channel - right points in workflow identify 3 of the 6 categories in the and provide an example of each. References Ash, J.S., et al. (2012). Recommended practices for computerized clinical decision support and knowledge management in community settings: A qualitative study. BMC Medical Informatics & Decision Making, Feb 14; 12:6. Bates, D.W., et al. (2003). Ten commandments for effective clinical decision support: Making the practice of evidencebased medicine a reality. Journal of American Medical Informatics Association, 10(6): Timbie, J.W., et al. A conceptual framework and protocol for defining clinical decision support objectives applicable to medical specialties. BMC Medical Informatics & Decision Making, 12: 93. Wright, A., et al. (2011). Development and evaluation of a comprehensive clinical decision support taxonomy: Comparison of front-end tools in commercial and internally developed electronic health record systems. Journal of American Medical Informatics Association, 18: GS2: IMPROVING OUTCOMES WITH CLINICAL DECISION SUPPORT Page 1 of 5
2 Improving Outcomes with Clinical Decision Support SUE SCHUBERT CHEESEMAN, DNP, APRN, NNP-BC CLINICAL INFORMATICS SPECIALIST ST LUKE S HEALTH SYSTEM, BOISE, ID Improving outcomes with CDS How do we make decisions? Why CDS? What is CDS? Five Rights of CDS How does CDS Work? Adoption of CDS Overview Improving outcomes with CDS How do we make decisions? Why CDS? What is CDS? Five Rights of CDS How does CDS Work? Adoption of CDS Objectives Define Clinical Decision Support Describe the Five Right of CDS right information right people right intervention i right channel right points in workflow Identify 3 of the 6 categories in the and provide an example of each How Do We Make Decisions? environment Econs (Bayesians) vs. Humans Perceptual psychology and behavioral economics Intuitive i statistics i Heuristics & biases Clinical reasoning Choice architecture Why Clinical Decision Support? What is Clinical Decision Support? Increased quality of care and enhanced outcomes Avoidance of errors and adverse events Increased efficiency Improved cost-benefit Enhanced provider and patient satisfaction A process for enhancing health-related decisions and actions with pertinent, organized clinical knowledge and patient information to improve health and healthcare delivery. Improving Outcomes with CDS, HIMSS 2012 Clinical decision support (CDS) provides clinicians, staff, patients or other individuals with knowledge and personspecific information, intelligently filtered or presented at appropriate times, to enhance health and health care. CDS encompasses a variety of tools to enhance decision-making in the clinical workflow. CDS at HealthIT.gov GS2: IMPROVING OUTCOMES WITH CLINICAL DECISION SUPPORT Page 2 of 5
3 Framework: The CDS Five Rights To improve targeted healthcare decisions and outcomes, well developed and deployed CDS interventions must provide: The right information (evidence-based, actionable...) To the right people (clinicians, patients...) In the right intervention format (alert, order set,...) Through the right channel (EHR, internet, mobile...) At the right points in workflow (decision/action...) Right Channel Right Channel Right Point in Workflow GS2: IMPROVING OUTCOMES WITH CLINICAL DECISION SUPPORT Page 3 of 5
4 How does CDS work? Clinical Decision Support Components Computable biomedical knowledge Personspecific data Reasoning or inferencing mechanism Combines knowledge and data to generate information Filtered & Organized Presented in context of the current workflow End user can make informed decision quickly and take action Clinical Decision Support Algorithms Filtered Organized Right Time in Workflow Medication Dosing Support (7) Formulary checking Default dose pick lists Order Facilitators (9) Complete order sentences Order sets Interactions Duplicates Critical values Relevant Display (5) Point of Care Alerts- Reminders (14) Patientspecific data Context sensitive user interfaces Filters Expert Systems (11) Antibiotic recommenda tions Calculators Guidelines Protocols Workflow Support (7) Order routing Registry functionality Medication Reconciliation Medication Dosing Support (7 Tools) Formulary checking Default dose pick lists Order Facilitators (9 tools) Complete order sentences Order sets Categories 6 Tools 53 Problem list Ventilator Management Diagnostics support Point of Care Alerts/Reminders Relevant Display Expert Systems Workflow Support Interactions Duplicates Critical Values Problem List Patient-specific data Context sensitive user interfaces Filters Antibiotic recommendations Calculators Guidelines Protocols Ventilator Management Diagnostic Support Order routing Registry Functionality Medication Reconciliation GS2: IMPROVING OUTCOMES WITH CLINICAL DECISION SUPPORT Page 4 of 5
5 Factors Influencing Adoption of CDS Payer initiatives to increase incentives for use of CDS Pay for performance eprescribing Meaningful Use Technology developments Commission for Certification of Healthcare Technology (CCHIT) The American Recovery and Reinvestment Act and Health IT Certification Clinical Decision Support Systems: State of the Art Resources HIMSS CDS Guidebook Series Open Clinical CDS/PI Collaborative: Getting Better Faster- Together (SM) HIMSS Resource Library: Clinical Decision Support Recommended Reading Improving Outcomes with Clinical Decision Support Bates DW et al. Ten commandments for effective clinical decision support: making the practice of evidence-based medicine a reality J Am Med Inform Assoc Nov-Dec;10(6): Ash JS et al. Recommended practices for computerized clinical decision support and knowledge management in community settings: a qualitative study. BMC Med Inform Decision Making Feb 14;12:6. Wright A et al. Development and evaluation of a comprehensive clinical decision support taxonomy: comparison of front-end tools in commercial and internally developed electronic health record systems. reality J Am Med Inform Assoc. 2011; 18: Timbie JW et al. A conceptual framework and protocol for defining clinical decision support objectives applicable to medical specialties. BMC Med Inform Decision Making. 12:93 8:30 9:30 AM General Session Improving Outcomes with Clinical Decision Support (Pharmacology CE 20%) The seminal Institute of Medicine, To Err is Human: Building a Safer Health System endorsed Clinical Decision Support (CDS) as one of the most powerful tools available in the national imperative toward improving patient safety and healthcare quality. CDS is a process for enhancing health care related decisions and actions with pertinent, organized clinical knowledge and patient information to improve health and healthcare. In this session, CDS interventions will be explored across the care continuum, providing different kinds of information to different care delivery participants in a variety of formats through different channels into various points in workflow. Susan Schubert Cheeseman, DNP, APRN, NNP BC cheesems@slhs.org GS2: IMPROVING OUTCOMES WITH CLINICAL DECISION SUPPORT Page 5 of 5
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