Question

Imagine that you have been appointed Director of Clinical
Decision Support at a healthcare delivery system. This healthcare
system consists of several large hospitals and multiple
outpatient clinics and uses the same EHR system across the
enterprise. There has been limited CDS activity at the institution
prior to your arrival. Now, with the increasing need to
provide increased care value, the appropriate use of CDS is
an institutional priority. The current CDS available at your
institution consists primarily of off-the-shelf drug-drug interaction
and drug allergy alerting, which is the source of significant
clinician complaints due to the rate of false-positive
alerts. There is a strong sense within the institution’s administration
that IT in general and CDS specifically should be leveraged
to improve care value and to enable the institution to
influence its clinical practice patterns more systematically and
more rapidly. You have a reasonable budget and adequate
staff to make meaningful changes and you do have support
from key institutional stakeholders, including healthcare system
executives, the nursing informatics officer, and the chief
medical informatics officer. You have been asked to devise
a strategic plan for CDS at your institution within 3 months
of your arrival and to have concrete “wins” within 12 to
18 months.
Discussion Questions
1. Describe the approaches you would use to ensure that all
aspects of patient care were considered when developing a
CDS system. How would you prioritize the efforts of your
CDS team? Potential areas on which to focus include areas
in which payment rates are tied to national quality measures,
CDS interventions that meet Meaningful Use
requirements, readmissions for congestive heart failure
and other care events for which payers are increasingly
not reimbursing, and areas that have been identified as
institutional priorities for clinical improvement.
2. How would you balance the need to deliver desired CDS
capabilities quickly against the benefits of establishing
robust infrastructure to enable future deliverables to be
implemented more quickly?
3. Identify one area for quality and value improvement.
Define the CDS interventions that you would implement
to address this area of need. Describe how your approach
aligns with the best practices discussed in this chapter,
such as the CDS Five Rights, the CDS 10 commandments,
and the desire to use standards-based, scalable approaches.
How would you systematically measure the impact of
these CDS interventions?

Answer 1

1) Ans) CDC for clinical decision support refers to providing the patients are physician with clinical knowledge and aur patient related information at appropriate time to enhance high quality of patients healthcare

The goal of any CDC system is to achieve high quality e and consistent and cost effective healthcare it also helps to prevention of error or omission improved Health care in terms of best choice of test following of guidelines prescribed improving in health care procedures and better communication between the patient and physician.

electronic health record is maintaining of all information relating to patients digital in one platform the informations are shared with each other system digitally while having a maintenance under one roof as said in our case study the current CTC available at our institutions consistof primary drug to drug interaction and drug allergy alerting which is to main forms of CDC across all the institution as they directly impact on patients Health care

Strategic plan of CDC at our institution":

# stakeholder - engagement of physicians nurses administrative staff is very important for effective CDC. the role of each of one of them is very vital in CDC goals and solving the problems are concerns of this institution.

# Translation of of clinical or institutional girls with CDC:
everyone must have appropriate knowledge of actions to be taken in case of emergency and health care alert there must be safety measures taken care of the patients in case of emergency an alert that the outcomes such emergency should not have bad impact on the patient's Health care each member of institutions are clinic must be aware of the obstacles that may come into the way of case such emergency and it must be well trained of how to use CDS at the point in time.

# Electronic healthcare record maintenance-electronic health record is one of the best way to keep all information relating to the patient the best thing about this approach is that everything is maintained electronically . it must be and sure that he has are is ethically, complaint it has different level of getting at right time for different user for any panic situation should have the decision rules that have accordance with the guidelines, rules, protocol ,was set by the institutions are the clinics.

# identification and building of CDC requirement achieving the institutional or the clinical course at any point in the day of workflow any physician and nurses administrative staff who is being asked for CDS must have access to the system

- Review testing approval should be in hands of physicians and nurses only for CDS are any alert like high BP due to stress at turning on or off the message are alert should be in hands of physicians and nurses only as they measure the pros and cons of situation take necessary actions on basis of patients health care for further improvement

- Training proper training must be given to the members of the institutions are clinic who should be well trained on what colour should be addressed first and whom should it be communicated relevant information is address and others are discarded and the immediate basis.

- feedback measures the results on timely basis of the current CTC and review and keep updating of the existing CDC take a proper feedback from the patient's family or friends on health care of the patients on mattress with the CDC was involved.

approaches that would be used to ensure all aspects of patient care are considered when developing a Sathish system are

*Active CDC it is displayed instantly as an alert for a message to the institutions are clinic using the electronic health record to provide the user with the an update on the issue or problem.it is in the form of pop up which requires users to accept or decline the message or pop up to the best of their knowledge on the basis of which that is relevant.

Passive CDC it is displayed on the basis of user setting it enables to all the information which user wants to show in the patient electronic health record and in what form other graph table are pie chart .and also here the user can have the access additional information relating to client health ,that involve training on what drug can be given together.

Effort of my CDC team will be e prioritised on the following manner:

-Collecting a list of message alert
-identifying whether it is relevant or important or ignorable
-evaluating which alert are message needs the immediate action
-communication about dalit are message to the concerned member in the team
- learn about the solution of alert with reference to the patience electronic health record
-make a schedule and fix appointment to solve the alerts
- taking actions on the message or alert to provide a quality Health care.

potential area of focus is to provide timely information about the patient, quality care, improve in patients help with increase awareness of error and avoidance ,improved efficiency of members of institutions and clinics and cost of effectiveness.

to balance the need to deliver the desired CDC capabilities quickly against the benefits of establishing the reversed infrastructure to ensure the future deliverables to be implemented

-best software is used to across the institution or clinic in electronic health record is one of such software

-There is one key person handling the software who then assigned duties accordingly .

- communicating on each alert are message to right person for a proper feedback or solution.

-To deliver the desired CDC on the time there must be a system integrated software installed that has the ability to cope up with errors and doesn't have impact on entire patient database.

area of quality and value improvement is training the members of institution or clinic on taking the promotion steps on solving any alert on the basis of patients existing the healthcare record mentioned in the electronic health record and minimising the error or omission or avoidance.