Question

Describe the approaches you would use to ensure that all aspects of patient care were considered when developing a CDS system. How would your prioritized 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, readmission for congestive heart failur÷ and other care events for which payers are increasingly not reimbursing, and areas that have been identified as institutional priorities for clinical improvement.

Answer 1

ANSWER :

CDS or Clinical Decision Support refers to providing patients or physicians with clinical knowledge and all patient related information at appropriate time to enhance high quality of patient’s health care.

The goal of any CDS system is to achieve high quality, consistent and cost effective health care. It also helps prevention of error or omission, improved health care in terms of – best choice of test, following of guidelines prescribed, improving in care procedure, better communication between patients and physicians, etc.

EHR or Electronic Health Record is maintaining of all information relating to patients digitally in one platform. The information’s are shared with each system digitally while having maintenance under one roof. As said in our case study, the current CDS available at our institutions consists of primarily drug-drug interaction and drug allergy alerting, which is two main forms of CDS across all the institution as they directly impact on patients healthcare.

Strategic Plan for CDS at our institution-

• Stakeholders- Engagement of physicians, nurses, administrative staffs is very important for effective CDS. The role of each one of them is very vital in CDS goals and solving problems or concerns of the institution.
• Translation of clinical or institutional goals with CDS- Everyone must have appropriate knowledge of actions to be taken in case of emergency and healthcare alert. There must be safety measure taken care of for the patients in any case of emergency and alert and the outcome of such emergency should not have bad impact on the patients healthcare. Each member of the institution or clinic must be aware of the obstacles that may come in the way in case of such emergency and they must be well-trained of how to use CDS at that point in time.
• Electronic Health Record Maintenance- EHR is one the best way to keep all information’s relating to the patients. The best thing about this approach is that everything is maintained electronically. It must be ensured that EHR is ethically compliant, it has different level of alerting at right time for different user for any panic situations, should have decision rules that are in accordance with the guidelines, rules, protocol’s set by the institution or clinics.
• Identification and building of CDS required achieving institutional or clinical goals at any point in the day to day workflow. Any physician, nurses or administrative staff who is being asked for CDS must have access to the system.
• Review, testing, approval should be in hands of physicians or nurses only for CDS- Any alert like High BP due to stress, turning on or off the message or alert should be in hands of physicians and nurses only as they measure the pros and cons of the situation and take necessary action on basis of patients healthcare for further improvement.
• Training –Proper training must be given to the members of the institution or clinic who should be well trained on what alert should be addressed first and whom should it be communicated. Relevant information is addressed and others are discarded on immediate basis.
• Feedback- Measure the results on timely basis of the current CDS and review and keep updating of the existing CDS. Take proper feedback from the patient’s family or friends on the health care of the patient on matters where CDS was involved.

Approaches that would be used to ensure that all aspects of patients care are considered when developing a CDS system are-

• Active CDS- It is displayed instantly as an alert or message to the institutions or clinics using EHR to provide the user with an update on the issue or problem. It is in a form of pop-up which requires user to accept or decline the message or pop-up to the best of their knowledge on the basis of which alert is relevant.
• Passive CDS- It is displayed on the basis of user settings. It enables to all the information which user wants to show in the patients EHR and In what form (graph, table, pie-chart, etc). Also here the user can have access additional information relating to clients health, that involves training on what 2 drug can be given together.

The effort of my CDS team will be prioritized on the following manner-

• Collecting list of messages or alert
• Identifying whether it is relevant/important or ignorable
• Evaluating which alert or message needs immediate action
• Communication about the alert or message to the concerned member in the team
• Learn about the solution of the alert with reference to the patients EHR
• Make schedules and fix appointments to solve the alerts
• Taking action on the message or alert to provide quality healthcare

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

To balance the need to deliver desired CDS capabilities quickly against the benefits of establishing a robust infrastructure to ensure future deliverables to be implemented quickly-

• Best software is used across the institution or clinic, EHR is one such software
• There is one key person handling the software who then assigns duties accordingly
• Communicating on each alert or message to the right person for proper feedback or solution
• To deliver desired CDS on time there must be a system integrated software installed that has the ability to cope up with the errors and doesn’t have impact on the entire patient’s database

Area of quality and value improvement is training the members of institution or clinic on taking prompt steps on solving any alert on basis of patients existing health care record mentioned in the EHR and minimizing the error or omission or avoidance.