Health Informatics- Module 3-Chapter 2.pptx
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The document outlines the role of electronic health records (EHR), clinical decision support systems (CDSS), and healthcare data analytics in improving healthcare delivery. It discusses the benefits of CDSS in enhancing patient safety, clinical management, and cost containment, while also highlighting challenges such as disrupted workflows and alert fatigue. Additionally, it emphasizes the need for comprehensive frameworks to enhance patient safety outcomes through effective health information technology incorporation.
Health Informatics- Module 3-Chapter 2.pptx
- 2. Module 3: Chapter 2 ELECTRONIC HEALTH RECORDS CLINICAL DECISION SUPPORT SYSTEMS HEALTHCARE DATA ANALYTICS
- 3. Module Content Electronic Health Records: purpose of electronic health records, popular electronic health record system, advantages of electronic records, challenges of electronic health records, the key players involved. Clinical Decision Support Systems: Making Decisions, the impact health information technology on the delivery of care in a rapidly changing healthcare marketplace. Healthcare Data Analytics: How is data analytics used in healthcare? example of data analytics in healthcare, types of analytics used in healthcare.
- 4. LearningObjectives Learn how to make Decisions usingCDW The impact health information technology on the delivery of care in a rapidly changing healthcare marketplace.
- 5. Clinical Decision Support Systems (CDSS) CDSS is “any software designed to directly aid in clinical decision making in which characteristics of individual patients are matched to a computerized knowledge base for the purpose of generating patient specific assessments or recommendations that are then presented to clinicians for consideration.” The scope of functions provided by CDSS is vast, including diagnostics, alarm systems, disease management, prescription (Rx), drug control, and much more. They can manifest as computerized alerts and reminders, computerized guidelines, order sets, patient data reports, documentation templates, and clinical workflow tools.
- 6. Clinical Decision Support available today Calculators, knowledge bases and differential diagnoses programs are primarily standalone programs but they are slowly being integrated into EHR systems.
- 7. Key interactions in knowledge- based and non- knowledge basedCDSS They are composed of (1) base: the rules that are programmed into the system (knowledge-based), the algorithm used to model the decision (non-knowledge based), as well as the data available, (2) inference engine: takes the programmed or AI- determined rules, and data structures, and applies them to the patient’s clinical data to generate an output or action, which is presented to the end user (eg. physician) through the (3) communication mechanism: the website, application, or EHR frontend interface, with which the end user interacts with the
- 8. Functions and advantages of CDSS Patient safety Strategies to reduce medication errors commonly make use of CDSS. Errors involving drug-drug interactions (DDI) are cited as common and preventable, with up to 65% of inpatients being exposed to one or more potentially harmful combinations. Computerized provider order entry (CPOE) systems are now designed with drug safety software that has safeguards for dosing, duplication of therapies, and DDI checking. The types of alerts generated by these systems are among the most disseminated kind of decision support. CDSS also improve patient safety through reminder systems for other medical events, and not just those that are medication related. Example: a CDSS for blood glucose measurement in the ICU was able to decrease the number of hypoglycemia events.This CDSS automatically prompted nurses to take a glucose measurement according to a local glucose monitoring protocol, which specified how often measurements should be done according to specific patient demographics and previous glucose levels/trends.
- 9. Functions and advantages of CDSS Clinical management Studies have shown CDSS can increase adherence to clinical guidelines.This is significant because traditional clinical guidelines and care pathways have been shown to be difficult to implement in practice with low clinician adherence. Furthermore, CDSS can assist with managing patients on research/treatment protocols, tracking and placing orders, follow- up for referrals, as well as ensuring preventative care. CDSS can also alert clinicians to reach out to patients who have not followed management plans, or are due for follow-up, and help identify patients eligible for research based on specific criteria.
- 10. Functions and advantages of CDSS Cost containment CDSS can be cost-effective for health systems, through clinical interventions, decreasing inpatient length-of-stay,CPOE- integrated systems suggesting cheaper medication alternatives or reducing test duplication.A CPOE-rule was implemented in a pediatric cardiovascular intensive care unit (ICU) that limited the scheduling of blood count, chemistry and coagulation panels to a 24-h interval. CDSS can notify the user of cheaper alternatives to drugs, or conditions that insurance companies will cover.
- 11. Functions and advantages of CDSS Administrative functions CDSS provide support for clinical and diagnostic coding, ordering of procedures and tests, and patient triage. Designed algorithms can suggest a refined list of diagnostics codes to aid physicians in selecting the most suitable one(s).A CDSS was conceived to address inaccuracy of ICD-9 emergency department(ED) admission coding (ICD is International StatisticalClassification of Diseases, standardized codes used to represent diseases and diagnoses).The tool used an anatomo-graphical interface (visual, interactive representation of the human body) linked to ICD codes to help ED physicians accurately find diagnostic admission codes faster. CDSS can directly improve quality of clinical documentation. Documentation accuracy is important because it can directly aid clinical protocols. For example, a CDSS was implemented to ensure patients were properly vaccinated following splenectomy, to combat the increased risk of infections (including pneumococcal, Haemophilus influenzae, meningococcal, etc.) that comes with spleen removal.
- 12. Functions and advantages of CDSS Diagnostics support CDSS for clinical diagnosis are known as diagnostic decision support systems (DDSS).These systems have traditionally provided a computerized ‘consultation’ or filtering step, whereby they might be provided data/user selections, and then output a list of possible or probable diagnoses. Unfortunately, DDSS have not had as much influence as other types of CDSS (yet) for reasons including negative physician perceptions and biases, poor accuracy (often due to gaps in data availability), and poor system integration requiring manual data entry.The latter is improving with better EHR-integration and standardized vocabulary like Snomed ClinicalTerms. Diagnostics support: imaging Knowledge-based imaging CDSS are typically used for image ordering, where CDSS can aid radiologists in selecting the most appropriate test to run, providing reminders of best practice guidelines, or alerting contraindications to contrast Diagnostics support: laboratory and pathology Another subset of diagnostics whereCDSS can be useful is laboratory testing and interpretation. Alerts and reminders for abnormal lab results are simple and ubiquitous in EHR systems. CDSS can also extend the utility of lab-based tests for the purpose of avoiding riskier or more invasive diagnostics.
- 13. Functions and advantages of CDSS Patient-facing decision support With the advent of the ‘Personal Health Record’ (PHR), we are seeing CDS functionality integrated, similar to EHRs, with the patient as the end user or ‘manager’ of the data.This is a great step towards patient-focused care, and CDS-supported PHRs are the ideal tool to implement shared decision-making between patient and provider, specifically because CDSS can remove a ‘lack of information’ as a barrier to a patient’s participation in their own care. PHRs are frequently designed as an extension of commercial EHR software, or as standalone web-based or mobile-based applications.When connected to EHRs, PHRs can have a two way relationship, whereby information entered directly by the patient can be available to their providers, and also information in the EHR can be transmitted to the PHR for patients to view.
- 14. Pitfalls of CDSS Fragmented workflows CDSS can disrupt clinician workflow, especially in the case of stand-alone systems. Many early CDSS were designed as systems that required the provider to document or source information outside their typical workspace.CDSS also disrupt workflow if designed without human information processing and behaviors in mind. In response,CDSS have been designed using the ‘think- aloud’ method to model practitioners’ workflow and create a system with better usability. Disrupted workflow can lead to increased cognitive effort, more time required to complete tasks, and less time face-to-face with patients. Even when CDSS are well integrated within existing information systems, there can be disconnect between face-to- face interactions and interaction with a computer workstation. Studies have found that practitioners with more experiential knowledge are less likely to use, and more likely to override CDSS.
- 15. Pitfalls of CDSS Alert fatigue and inappropriate alerts Studies have found up to 95% of CDSS alerts are inconsequential, and often times physicians disagree with or distrust alerts. Other times they just do not read them. If physicians are presented with excessive/unimportant alerts, they can suffer from alert fatigue. Disruptive alerts should be limited to more life-threatening or consequential contraindications, such as serious allergies. However; even allergy alerts can be incorrect, and clinicians will often verify themselves, especially if the source is another site/hospital/practitioner. Medication alerts can also be specialty specific, but irrelevant when taken out of context. For example, an alert against using broad-spectrum antibiotics such as vancomycin may be inappropriate in ICU.An alert against duplicate medications may be inappropriate in inflammatory bowel disease clinics, where the same class of drug can be applied through different administration routes for increased effect.
- 16. Pitfalls of CDSS Impact on user skill Prior to CPOE and CDSS, healthcare providers, pharmacists, and nurses were relied upon exclusively to double-check orders. CDSS can create the impression that verifying the accuracy of an order is unnecessary or automatic.This is an important myth to dispel. It is also important to consider the potential long-term effect of a CDSS on users. Over time a CDSS can exert a training effect, so that the CDSS itself may no longer be required. Coined the “carry- over effect”, it is most likely with CDSS that are educational in nature. Conversely, providers may develop too much reliance or trust on a CDSS for a specific task.This could be compared to using a calculator for mathematical operations over a long period of time, and then having poorer mental math skills. It is potentially problematic as the user has less independence and will be less equipped for that task should they switch to an environment without the CDSS.
- 17. Pitfalls of CDSS CDSS may be dependent on computer literacy Lack of technological proficiency can be hindering when engaging with a CDSS.This can vary by the design details of the CDSS, but some have been found to be overly complex, relying too much on user skill. Systems should aim to stay as close to the core functionality of the pre-existing system as possible. Regardless, all new systems have a learning period, and so baseline evaluations of users’ technological competence may be appropriate. Further training can then be provided to facilitate full use of CDSS capabilities, or more explicit guidance incorporated into the CDSS’ recommendations themselves.This information could be implemented as info buttons to be non-disruptive.
- 18. Pitfalls of CDSS System and content maintenance Maintenance of CDSS is an important but often neglected part of the CDSS life-cycle.This includes technical maintenance of systems, applications and databases that power the CDSS. Another challenge is the maintenance of knowledge-base and its rules, which must keep apace with the fast-changing nature of medical practice and clinical guidelines. Even the most advanced healthcare institutions report difficulty keeping their systems up to date as knowledge inevitably changes. Order sets and the algorithmic rules behind the CDSS have been identified as particularly difficult.
- 19. Pitfalls of CDSS Operational impact of poor data quality and incorrect content EHRs and CDSSs rely on data from external, dynamic systems and this can create novel deficiencies. As an example, some CDSS modules might encourage ordering even when the hospital lacks adequate supplies. In a study by Ash et al., a number of experts indicated that at their hospital, Hemoccult tests or pneumococcal vaccine inventories run out quickly, but this is not communicated to the CDSS. In poorly designed systems, users may develop workarounds that compromise data, such as entering generic or incorrect data.The knowledge base of CDSS is dependent on a centralized, large clinical data repository. Quality of data can affect quality of decision support. If data collection or input into the system is unstandardized, the data is effectively corrupted.You may design a system for use at the point-of-care, but when applied to real world environments and data, will not be utilized properly.The importance of using informational standards such as ICD, SNOMED, and others, cannot be understated.
- 20. Pitfalls of CDSS Lack of transportability and interoperability Despite ongoing development for the better part of three decades, CDSS (and even EHRs in general) suffer from interoperability issues. ManyCDSS exist as cumbersome stand- alone systems, or exist in a system that cannot communicate effectively with other systems. What makes transportability so difficult to achieve? Beyond programming complexities that can make integration difficult, the diversity of clinical data sources is a challenge.There is a reluctance or perceived risk associated with transporting sensitive patient information.
- 21. Pitfalls of CDSS Financial challenges Up to 74% of those with a CDSS said that financial viability remains a struggle. Outset costs to set up and integrate new systems can be substantial. Ongoing costs can continue to be an issue indefinitely as new staff need to be trained to use the system, and system updates are required to keep pace with current knowledge. Results from cost analyses of CDSS implementations are mixed, controversial, and sparse.Whether an intervention is cost- effective depends on a wide range of factors, including those specific to the environment, both political and technological. Cost benefit assessment in itself can be limited, with challenges such as a lack of standardized metrics.This is an emerging research area and much work needs to be done to advance our understanding of the financial effects of CDSS.
- 22. The impact health information technology on the delivery of care in a rapidly changing healthcare marketplace Summary of Health InformationTechnology (HIT) on patient safety
- 23. A comprehensiv e framework for organizations looking to improve patient safety outcomes 1. Health Information Governance. Organizations must establish a health information oversight mechanism that includes leadership and relevant stakeholders. In addition, organizations need to ensure that their health information plan is coordinated with the organization’s patient safety and risk management plan. 2. Safety Risk Identification. Organizations need to identify areas that health information technology might aid in improving patient safety namely, medication safety, guideline adherence, and so forth. 3. Stake-Holder Involvement: Stakeholders need to be involved in all phases of health information projects from planning and implementation until continuous improvement.The most important stakeholder must be the system end-user and process owner. 4. Informed Decision: Organizations need to review the cost effectiveness of suggested technologies, which includes conducting an evidence based decision and an evaluation of the current information technology infrastructure including software and hardware.
- 24. A comprehensiv e framework for organizations looking to improve patient safety outcomes 5. SufficientTraining: Organizations need to ensure that all relevant line staff receive sufficient training on the use of the proposed health information technology. 6. Gradual Implementation: Rolling out the technology in a gradual stepped approach is crucial to avoid disruption of current processes and systems. 7. Continuous evaluation and monitoring of patient safety outcomes: Organizations need to measure patient safety outcomes on a continuous basis especially during the initial implementation to ensure that the new technology achieves its intended outcome. 8.Technology optimization: Organizations need to modify and finetune the implemented technology based on user feedback and patient safety outcomes. 9. Regular technology updates: Organizations must ensure that health information technologies are continuously updated to comply with recent best clinical practices, regulatory standards, and technical stability.
- 25. ThankYou!