Course Syllabus Instructors: Dr. Robert Hayward (robert.hayward@ualberta.ca, 780-492-6633) Assistant: Gisele Hoskinson (giseleh@ualberta.ca, 780-492-7431) Office: 2100 RTF, University of Alberta Office hours: Tuesdays 0900-1200 MST Course Term: September 11 December 10, 2008 Course Time: Self-directed Classroom: Online Textbook: Course readings are assigned and available online. There is no required textbook. The following guide is strongly recommended: Osheroff JA, Pifer EA, Teich JM, Sittig DF, Jenders RA. Improving Outcomes with : An Implementer s Guide. Healthcare Information and Management Systems Society: 2005. (available via www.himss.org/cdsguide) Description: (CDS) is defined as systems that link health observations with health knowledge to influence health choices for improved health care. Clinical decision support cannot occur in the absence of accurate health information. Nor can it occur in the absence of any knowledge about what works in health care. Decision support systems, therefore, offer a practical approach to connecting evidence with action. This course will provide an overview of clinical decision support (CDS) systems and methods. Online learning modules define and describe the different types of decision support tools in common use, highlight benefits and risks inherent to CDS systems, and outline a rationale for deciding whether decision support systems are effective. Students appraise research about CDS interventions, and are introduced to CDS tools and techniques that will help them make informed decisions within their organization and participate in strategic planning activities. Objectives: By the end of this course students should be able to: Define both CDS and the systems that provide a digital context for CDS Recognize different types of CDS and anticipate likely benefits and harms associated with each type Find health literature, policies and standards pertaining to CDS Appraise research reports about the effects of CDS systems Given a particular CDS product, describe important properties and anticipate implementation issues Code of Student Behaviour: Course participants should be aware of University policies relating to academic integrity ( http://web.uvic.ca/calendar2007/facs/unin/uare/poaci.html ). Course Syllabus 2008-09-10 1 of 7
Course Topics The course consists of 10 self-directed learning modules, a critical appraisal project and a product assessment project. Each learning module includes an online presentation, required readings, suggested readings, information resources, learning activities and discussion groups. The mid-term appraisal project entails selection of a research article about the effects of CDS and an appraisal of the validity, importance and applicability of the research findings. Students can select from among a list of suggested articles. The final CDS evaluation project entails selection of a demonstration CDS product, hands-on experience using the product, then submission of an assessment of the product type, integration interface, and likely implementation issues. Learning modules 1. CDS Virtual Learning Community (online presentation and demonstration) a. Course overview b. Orientation to the online learning environment for this course c. Description and illustration of mid-term and final projects d. How to select an article for CDS appraisal project e. Trying and selecting demonstration CDS systems for project assessment project f. Access to CDS Clearinghouse, readings and resources g. Complete interactivities about information access, personal workspaces, public workspaces, demonstration CDS products, evaluations, learning modules, internet conferencing and project deliverables. 2. Conceptual Framework a. Digital context for CDS b. Definitions of CDS c. Taxonomy of CDS systems d. Modeling CDS workflow 3. Finding Information about CDS a. CDS Clearinghouse b. Search strategies for bibliographic databases c. CDS repositories d. CDS grey literature e. RefWorks citation collection f. Book-marking skills for personal evidence collection 4. Appraising CDS Research a. Types of CDS inquiry b. Evaluating impacts of complex informational interventions c. Causal chains d. CDS Appraisal Guides 5. State of CDS Science a. What is known about the benefits and harms of CDS b. How knowledge about CDS has been generated c. Volatility of evidence about CDS d. Emerging evidence about CDS-associated harms Course Syllabus 2008-09-10 2 of 7
e. Gaps in knowledge and ways of knowing 6. State of CDS Standards a. Server-side integration b. Client-side integration c. Coding protocols d. Messaging protocols 7. State of CDS Policy a. CDS in the national blueprint (InfoWay) for Electronic Health Record Systems b. CDS implications of national and regional patient safety initiatives c. Medico-legal implications of CDS interventions d. Liability implications of a standard of care that includes access to CDS 8. State of CDS Products a. Overview of types of CDS products and services currently available b. Trends in CDS vendors c. Disease Guidance Systems d. Disease Management Systems 9. State of CDS Practice 1 Ambulatory Care (Guest presentation, Dr Allen Ausford) a. CDS opportunities and issues from a primary care perspective b. Best and worst practices from the front lines 10. State of CDS Practice 2 Institutional Care (Guest presentation, TBD) a. CDS priorities and issues in hospital settings b. Best and worst practices reported by CDS pioneers c. Organizational facilitators and barriers to CDS gains in health institutions Appraisal Projects All student appraisals will be posted to the online learning environment twice weekly through an online journal-club. Students are expected to participate in online discussion about the appraised articles. Assessment Projects All students are expected to assess one of the CDS products, tools or methods provided through the course online learning environment. These assessments are shared with all members of the online learning community. Course Syllabus 2008-09-10 3 of 7
Course Delivery This course is delivered using an Internet Virtual Learning Community (VLC). This offers a common point of access to all course readings, handouts, quizzes, references, databases and other pertinent information resources. Course participants can join online discussions, practice course concepts through interactivities and complete assignments online. The online learning environment automatically records participation in online learning activities and discussions. Most importantly, the VLC provides access to multiple CDS products and information sharing tools. In this way, the course uses the internet to support experiential learning. Students learn a variety of CDS-relevant collaboration practices while completing their course requirements. Access to a personal or University computer with an Internet connection is necessary to complete the requirements of this course. Participants should have access to high-speed Internet services at least 3 hours per week. The CHECDS virtual classroom is powered by VIVIDESK technology. In order to acquire an account and download the software, please visit: http://www.cche.net/checds. VIVIDESK Technical Requirements: Internet Connection (preferably high-speed) Internet Explorer 5 (IE 5.5 or more recent strongly recommended; does not have to be default browser) Windows 98 or more recent operating system (Windows 2000 or XP strongly recommended) Display monitor resolution set to 1024*768 or better, 16K colours or better Adobe Reader (current version) to view some documents. Macromedia Flash Player (current version) to view video presentations and demonstrations. For most computers, you will need administrator rights to install the VIVIDESK software. If you do not have the right to install Internet components, or if you are not sure, contact your network administrator for assistance. In order to listen to the video presentations or participate in any online conferences, you will need a sound card and either speakers or a headphone. Most personal computers are so equipped but many University computer laboratory computers are not. If you will be using headphones, consider buying good quality computer headset with a noise-reduction microphone. All correspondence about the course will be sent by email or posted to the virtual classroom bulletin board. Course Syllabus 2008-09-10 4 of 7
Course Deliverables Critical Appraisal Project (30%) All students submit a critical appraisal of an original research report about the results of a CDS implementation study. A collection of approximately 10 articles is provided; from which students select one article for careful review. Using critical appraisal guides introduced in session 4, students complete an online appraisal "interactivity" in time for the mid-term submission deadline (equivalent 2-4 pages). The appraisal is conducted using guides to assessing the validity, importance and applicability of decision-support intervention studies, as described in the Users Guides to the Medical Literature. The Users Guides, relevant readings, appraisal worksheets and appraisal tools are provided online. Completed Appraisal Projects are available to the course instructors online. In addition, the project reports are submitted to an online CDS "Journal Club", which is posted to the CDS Desktop (online learning environment) by the submission deadline. By using a journal-club format, students gain experience with this approach to continuing professional learning. Submitted appraisal projects are informally evaluated through peer discussion and feedback. All appraisal projects are also marked and students are provided with instructor feedback. CDS Product Assessment Project (40%) The CHECDS Virtual Learning Community provides single-sign-on access to a private collaborative workspace. A number of CDS vendors have agreed to provide working copies of their products for review by students. In some cases, CDS-relevant tools, technologies or methods (e.g. InfoButton integration protocol) are provided. All course participants are expected to complete a "CDS Product Assessment" for a product or technology that is: made available via the CHECDS Desktop, or publicly available via an Internet link that can be posted to the Desktop. Each student selects one product for detailed assessment. Students may not select a product or company with which they have any prior relationship or experience. Students apply what they have learned by defining, classifying, and describing key attributes of the chosen CDS product. Additionally, students are expected to discuss how the product might be used in practice, what integration methods it supports, and what end-user impacts might be expected. A suggested report template will be provided via the CHECDS Desktop. All product assessment reports are completed and submitted online, for review and discussion by both peers and instructors. Ideally, students will submit draft reports in advance of the product assessment submission deadline. This will facilitate peer review and allow revision prior to final submission. Final reports are assessed by the instructors and contribute to the final course grade. Course Syllabus 2008-09-10 5 of 7
Interactivities (15%) Most learning units provide short online interactivities that allow students to evaluate their understanding of key concepts. Once completed, students commit their responses and these are reviewed by the course facilitators. An aggregate mark for all interactivities is assigned at course completion. Participation (15%) The CHECDS Virtual Learning Community records time spent evaluating CDS products, participating in discussions and providing peer feedback on both Critical Appraisal Projects and Product Assessment Projects. These records, with consideration for participation in online conferences, are used to assign a course participation mark. Course Syllabus 2008-09-10 6 of 7
Evaluation The final grade will be based on: Critical Appraisal Project (30%) CDS Product Assessment Project (40%) Interactivities (15%) Participation (15%) Grading Scheme Numerical Marks Letter Grade GPA 90-100 A+ 9 85-89 A 8 80-84 A- 7 75-79 B+ 6 70-74 B 5 65-69 B- 4 60-64 C+ 3 55-59 C 2 50-54 D 1 Course Syllabus 2008-09-10 7 of 7