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Health IT and Clinical Decision Support

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Health IT and Clinical Decision Support

  1. 1. Egypt: Health IT and Clinical DecisionSupport C. William Hanson III MD
  2. 2. Feedback loop: Decision Support and Data CDS CDS (tailored health info (best practice guidelines) for pts/pops) ALERTS ALERTS Realtime dashboard Realtime dashboard (provider/population level) (pt/pop level) 2
  3. 3. Core competencies of a Health System Desired Core Characteristics of the “Best Prepared” CompetenciesPhysician A highly aligned medical staff characterized by outcome-based contractual arrangements,Integration (pg. 6) collaborative planning, and adequate representation in organizational governance.Care Coordination Use of care coordination tools and processes by an empowered and integrated workforce to meet(pg. 7) performance goals that are regularly measured and reported.Cost Management A right-sized organization-wide cost structure highlighted by appropriate levels of staffing, capital(pg. 8) spend and supply chain costs constantly reviewed based on comparative peer group studies and benchmarks.Information An enterprise-wide IT platform that supports clinical and business decision making, informationSystems management and utilization, access by all stakeholders (physicians, patients, administration).Sophistication (pg. 9)Balanced Service A rational service distribution system that has accessible primary care, easy access across theDistribution (pg. 10) care continuum and is based on contemporary facilities and equipment; minimal clinical service duplication across the system.Payor Maintaining strong relationships with payers and having the ability to negotiate support for “new-Relationships/ era” contract terms/mechanisms, as well as influence product design.Contracts (pg. 11)Financial/Capital Strong appeal to capital markets through sustained strength in operations, revenue growth,Capacity (pg. 12) profitability, liquidity and balance sheet strength.Scale/ Sufficient scale in the market to attract competitive clinical and administrative talent, realizeEssentiality (pg. 13) operating and capital economies, drive marketplace innovation and be an essential provider to health plans and patients; optimal portfolio of business units, service lines, and assets that permit the System to achieve its organizational goals and reflect the emerging model for the delivery of care. Source: Kaufman, Hall & Associates, Inc. Reproduced, and modified, with permission 3
  4. 4. Using the Five Rights of CDS to Improve Outcomes at Penn THE FIVE RIGHTS HOW WE ARE DOING IT WHAT IT LOOKS LIKE AT PENN MEDICINEThe Right Information… Requests are prioritized and Evidence-based, useful for informed by reviews of the guiding action and answering evidence questions…to the Right Program Manager works with Both clinicians and patientsStakeholder… requestor to ensure the right stakeholders are involved…in the Right Format… • Interventions are vetted Alerts, Order Sets, through the CDS workgroup InfoButtons, etc. •Technical and clinical…through the Right expertise informs the Electronic medical record,Channel… intervention designs internet, mobile devices •The impact of all…at the Right Point in the To influence key interventions are measuredWorkflow. decisions/actions through reports 4
  5. 5. Passive DSS “What do you think?” 5
  6. 6. Passive Decision Support  Relevant Data Presentation • Facilitate decision making  Documentation forms/templates • Enforce required data entry  Order and Data Entry Forms • Automated calculation • Correct orders • Present needed lab results  Order Sets • Group of orders related to a clinical condition (trauma, MI) 6
  7. 7. Expert systems (Mycin) “Should I refer?” 7
  8. 8. Diagnostic DSS 8
  9. 9. Diagnostic DSS 9
  10. 10. Pathways 10
  11. 11. Semi-active DSS “I’d suggest the following” 11
  12. 12. Order entry (drugs) with alerts X 12
  13. 13. Order entry (radiology) Decision Support If “Ignore” is selected, Peer-To-Peer screen is presented 13 13
  14. 14. 14 14
  15. 15. Active Decision Support “So this is what I did” 15
  16. 16. Active Decision Support  Urgent notice generated by the system  Immediate notification of an error or hazard recognized by the system based on new data or the passage of time during which something should have occurred (but didn’t) 16
  17. 17. DSS - Autonomous systems  Automated medication administration  AICD 17
  18. 18. AICD 18
  19. 19. Decision Support: Liability 19
  20. 20. Decision Support: Is it trustworthy? “Apply leeches and let blood” 20
  21. 21. HOW DO YOU BUILD DSS? 21
  22. 22. Current State IT Analyst IT Report CDS Workgroup Writer Key Stakeholders Requestor of CDS Intervention CDS Program Manager CDS Workflow: 1 CDS Workflow: 2 CDS Workflow: 3 CDS Workflow: 4 CDS Workflow: 5 CDS Catalog• Program • PM • PM works • PM presents • Revised CDS • Final scoping Manager (PM) coordinates with IT staff to CDS is tested, document, works with with to create a Workgroup finalized, and screen shots, requestor to relevant requestor draft CDS, for review slated for evidence identify scope, report and and comment release reports, and champions at content and education baseline and each UPHS follow-up data entity as reporting tool needs catalogued appropriate 22
  23. 23. Using the Five Rights of CDS to Improve Outcomes at Penn THE FIVE RIGHTS HOW WE ARE DOING IT WHAT IT LOOKS LIKE AT PENN MEDICINEThe Right Information… Requests are prioritized and Evidence-based, useful for informed by reviews of the guiding action and answering evidence questions…to the Right Program Manager works with Both clinicians and patientsStakeholder… requestor to ensure the right stakeholders are involved…in the Right Format… • Interventions are vetted Alerts, Order Sets, through the CDS workgroup InfoButtons, etc. •Technical and clinical…through the Right expertise informs the Electronic medical record,Channel… intervention designs internet, mobile devices •The impact of all…at the Right Point in the To influence key interventions are measuredWorkflow. decisions/actions through reports 23
  24. 24. Development of DSS rule or alert (process) 24
  25. 25. Admission Order Set (CDS) 25
  26. 26. Urinary catheter CDS tool 26
  27. 27. Alerting and alert fatigue  Alert • Must be specific (patient) • Must be targeted (provider, caregiver) at someone who can act efficiently • Must be timely and convenient • Must come with relevant content 27
  28. 28. Epic drug alerts 28
  29. 29. Feedback loop: the patient CDS CDS (tailored health info (best practice guidelines) for pts/pops) ALERTS ALERTS Realtime dashboard Realtime dashboard (provider/population level) (pt/pop level) 29
  30. 30. Decision support for the patient 30
  31. 31. 31
  32. 32. 32
  33. 33. 33
  34. 34. Feedback loop: Decision Support and Data CDS CDS (tailored health info (best practice guidelines) for pts/pops) ALERTS ALERTS Realtime dashboard Realtime dashboard (provider/population level) (pt/pop level) 34
  35. 35. Data 35
  36. 36. Data visualization 36
  37. 37. Decision support for the leaders Decision Making & Analyze Action Information Decision Making & Action % Time Spent Analyze Information Collect Data Analyze Information Collect Data Collect Data Classic Reporting BI & Analytic Tools First Generation EIM Less Mature More Mature 37
  38. 38. Vision: Enterprise Analytics - Cost per Case - ALOS - Quality Compliance C-Level / Strategic Planning • Cost savings opportunities by standardizing material and implant choices - Core Measures • Case Volume by Specialty – market alignment - ASA AQA • Improve resource utilization; patient satisfaction - NSQIP Executive Quality Department User • Reduce costs by automating report development • ID opportunities to reduce SSI’s, re-admits, ALOS • Improve compliance with regulatory mandates Functional User Analyst / Informaticist/Service Power User Leads/UBCL directors • Analytic & reporting tools - SCIP, PN, AMI • Report development and distribution - Beta-blocker • Monitor data quality; standardize vocab. - Foley Catheter - PNDSThe Right Information. To the Right People. At the Right Time. 38

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