Discussion: Informatics Solution Proposal General Solution Paper

Discussion: Informatics Solution Proposal General Solution Paper ORDER NOW FOR CUSTOMIZED AND ORIGINAL ESSAY PAPERS ON Discussion: Informatics Solution Proposal General Solution Paper • Determine a category of informatics or technology that can solve the clinical or administrative issue you identified in Week 2. Discussion: Informatics Solution Proposal General Solution Paper Compose a summary of the benefits of selecting a product from this category of technology or informatics system: • Identify a category of informatics or technology solution that may be appropriate for the identified workplace. Select a category of solution but not a specific product. • Provide a rationale for why this category of solution may help address the clinical or administrative problem. • Describe regulatory, legal, or ethical issues this category of solution may cause or resolve. Format your assignment as one of the following: • legal-sized infographic • 350- to 525-word paper Include a minimum of three peer-reviewed sources, and develop an APA-formatted reference page. informatics_solution_proposal_wk2_.docx chaper_readings.pdf wk3_grading_rubrix.docx Running Head: MEMO 1 Informatics solutions Name Course Institutional Affiliation Memo 2 Memo to a Nursing Administrator Date: October 29, 2018 To: Nursing administrator From: Mr. Grey, RN, nurse manager Re: Administrative problem: Loss of patient’s data. As it is that customer satisfaction is the main focus for quality healthcare delivery, and since there are increased trends in technology and patient requirements, our facility needs to upgrade to the latest technology to remain competitive. Patients find it difficult to keep up with the different providers, their medication, diagnosis and lab testing hence repeated tests lead to increased health care costs and the loss of data in the process (Raghupathi & Raghupathi, 2014). Much is time spent on looking for the information thus reduces nurse’s productivity, affects communication between the patients and providers and can result in the provision of low-quality health care. Patients deserve to have easy access to health records mainly to avoid repeated tests that increase the cost of healthcare. With the new technical solution, designing personal health information that the patients can access online becomes very efficient (Carayon, Wetterneck, Rivera-Rodriguez, Hundt, Hoonakker, Holden & Gurses, 2014). There can be one or several online databases that safely store the information, and the patient will need verification methods such as user password or pin verification to access their personal information. They will not have to go through the long queues of waiting for the nurse to retrieve their data and continue with their treatment thus will be treated on time, and the nurse will also be able to respond to patient’s questions on time. Memo 3 I, therefore, request to propose a technical solution that will provide patients with easily accessible and comprehensive overview of their healthcare history. That will be designing an appropriate personal health records (PHR) system that provides various functions to solve patient’s needs and to save on time and money hence have better management of their care (Miotto, Kidd & Dudley, 2016). Patients will not only access their healthcare records but will also be able to pay their medical bills and renew their medication plans thus improving quality patient care. The use of PHR systems will also reduce the administrative costs as the nurse spend less time searching for information and responding to patient’s needs hence can use their time efficiently to perform their roles that are productive to the hospital and will ensure the provision of quality healthcare. Memo 4 References Carayon, P., Wetterneck, T. B., Rivera-Rodriguez, A. J., Hundt, A. S., Hoonakker, P., Holden, R., & Gurses, A. P. (2014). Human factors systems approach to healthcare quality and patient safety. Applied Ergonomics, 45(1) Miotto, R., Li, L., Kidd, B. A., & Dudley, J. T. (2016). Deep patient: an unsupervised representation to predict the future of patients from the electronic health records. Scientific reports, 6, 26094. Raghupathi, W., & Raghupathi, V. (2014). Big data analytics in healthcare: promise and potential. Health information science and systems, 2(1) Clinical Decision Support Systems: State of the Art Prepared for: Agency for Healthcare Research and Quality U.S. Department of Health and Human Services 540 Gaither Road Rockville, MD 20850 www.ahrq.gov Prepared by: Eta S. Berner, Ed.D. Department of Health Services Administration University of Alabama at Birmingham AHRQ Publication No. 09-0069-EF June 2009 This document is in the public domain and may be used and reprinted without permission, except for any copyrighted materials noted, for which further reproduction is prohibited without the specific permission of the copyright holders. Suggested Citation: Berner ES. Clinical decision support systems: State of the Art. AHRQ Publication No. 09-0069-EF. Rockville, Maryland: Agency for Healthcare Research and Quality. June 2009. Acknowledgments The author appreciates the support of Jerome Osheroff, M.D., and Robyn Tamblyn, Ph.D., who both provided valuable input at several stages in development of this white paper and reviewed an earlier draft. The findings and conclusions in this report are those of the authors, who are responsible for its content, and do not necessarily represent the views of AHRQ. No statement in this report should be construed as an official position of the U.S. Department of Health and Human Services. ii Contents Introduction……………………………………………………………………………………………………………………..4 Types of Clinical Decision Support…………………………………………………………………………………….5 Technological Underpinnings……………………………………………………………………………………….5 Target Area of Care …………………………………………………………………………………………………….5 Delivery of CDS Recommendations to Users …………………………………………………………………6 User Control……………………………………………………………………………………………………………….Discussion: Informatics Solution Proposal General Solution Paper 7 Impact and Effectiveness of CDS ……………………………………………………………………………………….8 Impact on Care Process And Patient Health Outcomes…………………………………………………….9 Impact on Structure……………………………………………………………………………………………………12 Design and Implementation of CDS ………………………………………………………………………………….13 Workflow Integration…………………………………………………………………………………………………14 Data Entry and Output ……………………………………………………………………………………………….15 Standards and Transferability ……………………………………………………………………………………..15 Knowledge Maintenance ……………………………………………………………………………………………16 Clinician Motivation to Use CDS ………………………………………………………………………………..17 Evaluation ……………………………………………………………………………………………………………………..17 Factors in the Current U.S. Health Care Environment Facilitating Broader Utilization of CDS ..18 Payer Initiatives to Increase Incentives for Use of CDS………………………………………………….19 Technological Developments………………………………………………………………………………………19 Summary ……………………………………………………………………………………………………………………….20 References……………………………………………………………………………………………………………………..20 Tables Table 1. Examples of CDS interventions by target area of care………………………………………………6 Table 2. CDS intent and key issues …………………………………………………………………………………….8 iii Introduction Clinical decision support (CDS) systems provide clinicians, staff, patients, and other individuals with knowledge and person-specific information, intelligently filtered and presented at appropriate times, to enhance health and health care.1 The Institute of Medicine has long recognized problems with health care quality in the United States, and for more than a decade has advocated using health information technology (IT), including electronic CDS, to improve quality.2-5 Since 2004, when the Federal Government promoted the importance of electronic * medical records (EMRs), there has been a slow but increasing adoption of health IT.7-9 It must be remembered, though, that these health IT applications are a means to improve health care quality, not an end in themselves.10 Further, although EMRs with computerized provider order entry (CPOE) can improve accessibility and legibility of information, it is unlikely that there will be major improvements in the quality and cost of care from the use of health IT without proper implementation and use of CDS.11-15 To illustrate this point, imagine the following scenario: While his doctor is out-of-town, an elderly asthma patient who has developed severe knee pain sees another physician in his doctor’s office. An EMR provided documentation of the last visit, including recent laboratory results and a list of the patient’s medications. This information easily brought the doctor up to date on the patient’s condition. The doctor entered an order for medicine for the knee pain into the system, printed out a (legible) prescription for the patient, and sent him on his way. Unfortunately, within 2 months, the patient wound up in the emergency room with a bleeding ulcer caused by interaction of the pain medicine with the patient’s asthma medicine. Problems of this kind occur frequently, as documented in reports from the Institute of Medicine.4,5,16 Any of several types of CDS tools could have prevented this patient’s drug interaction. Examples include a pop-up alert to the potential drug interaction when the doctor prescribed the new medicine; clinical prediction rules to assess the risks of the pain medication for this patient; clinical guidelines for treatment of asthma; or reminders for timely followup. This scenario illustrates that EMRs are the foundation for patient safety and health care quality improvement, but CDS is an essential element in fully realizing these goals. This review presents a summary of the state of the art of electronic CDS for clinicians. It includes background information on the types of CDS and focuses on the outcomes of deploying these CDS interventions. It also discusses the major issues and challenges of CDS implementation and evaluation. After reviewing what is known about implementing CDS, the impact from its use, and the knowledge gaps that remain, the review examines factors that can facilitate broader use of CDS, including the role of various stakeholders in influencing CDS adoption. This review uses both the peer-reviewed literature on implementation and outcomes of * Recent consensus definitions have made a distinction between EHRs (electronic health records, records that span organizations), and EMRs (electronic medical records that contain information from a single organization).6 As technology develops there will likely be more development of EHRs, but since EMRs are more common today the term EMR will be used throughout this paper. 4 CDS and a variety of books, white papers, and recommendations put forth by national organizations in recent years. Types of Clinical Decision Support Early CDS systems were derived from expert systems research, with the developers striving to program the computer with rules that would allow it to “think” like an expert clinician when confronted with a patient.Discussion: Informatics Solution Proposal General Solution Paper 17 From this early research there was growing recognition that these systems might be useful beyond research, that they could be used to assist clinicians in decision making by taking over some routine tasks, warning clinicians of potential problems, or providing suggestions for clinician consideration.5,18 This review focuses on CDS systems of a type known as knowledge-based CDS because they include compiled clinical knowledge. There have been several descriptions of types of CDS and their characteristics.18-22 Osheroff and colleagues have provided a detailed taxonomy of CDS functions.18 Many of the early CDS systems provided expert consultation to the clinician for diagnosis and medication selection. CDS today also encompasses a range of options, from general references, through specific guidelines for a given condition, to suggestions that take into account a patient’s unique clinical data. CDS can include nationally recommended guidelines at one end of the continuum and customized order sets designed by an individual clinician at the other. Technological Underpinnings Common features of CDS systems that are designed to provide patient-specific guidance include the knowledge base (e.g., compiled clinical information on diagnoses, drug interactions, and guidelines), a program for combining that knowledge with patient-specific information, and a communication mechanism—in other words, a way of entering patient data (or importing it from the EMR) into the CDS application and providing relevant information (e.g., lists of possible diagnoses, drug interaction alerts, or preventive care reminders) back to the clinician. CDS can be implemented using a variety of platforms (e.g., Internet-based, local personal computer, networked EMR, or a handheld device). Also, a variety of computing approaches can be used. These approaches may depend on whether the CDS is built into the local EMR, whether the knowledge is available from a central repository (possibly outside the local site and accessed and incorporated locally when needed), or whether the entire system is housed outside the local site and is accessed, but not incorporated into the local EMR. In principle, any type of CDS could utilize any of these underlying computational architectures, methods of access, or devices. The choices among these elements might depend more on the type of clinical systems already in place, vendor offerings, workflow, security, and fiscal constraints than on the type or purpose of the CDS. Target Area of Care Many of the technology differences described in the previous section need not be apparent to the user. The following factors may be more relevant to the clinician user or those assisting with 5 implementation: (1) the primary need or problem and the target area of care for which the CDS is being considered (e.g., improve overall efficiency, identify disease early, aid in accurate diagnosis or protocol-based treatment, or prevent dangerous adverse events affecting the patient); (2) to whom and how the information from the CDS will be delivered; and (3) how much control the user will have in accessing and responding to the information. A key decision is whether CDS can help solve the need or problem identified. CDS can provide support to clinicians at various stages in the care process, from preventive care through diagnosis and treatment to monitoring and followup. CDS as implemented today can include, for example, order sets tailored for particular conditions or types of patients (ideally based on evidence-based guidelines and customized to reflect individual clinicians’ preferences), access to guidelines and other external databases that can provide information relevant to particular patients, reminders for preventive care, and alerts about potentially dangerous situations that need to be addressed. The most common use of CDS is for addressing clinical needs, such as ensuring accurate diagnoses, screening in a timely manner for preventable diseases, or averting adverse drug events.23 However, CDS can also potentially lower costs, improve efficiency, and reduce patient inconvenience. In fact, CDS can sometimes address all three of these areas simultaneously—for example, by alerting clinicians to potentially duplicative testing.Discussion: Informatics Solution Proposal General Solution Paper For more complex cognitive tasks, such as diagnostic decisionmaking, the aim of CDS is to assist, rather than to replace, the clinician,24,25 whereas for other tasks (such as presentation of a predefined order set) the CDS may relieve the clinician of the burden of reconstructing orders for each encounter.18 The CDS may offer suggestions, but the clinician must filter the information, review the suggestions, and decide whether to take action or what action to take. Table 1 below provides examples of CDS that address a range of target areas. For more examples of how various types of CDS can be applied to addressing specific improvement objectives, see the work of Osheroff and his colleagues.18 Table 1: Examples of CDS interventions by target area of care Target Area of Care Example Preventive care Immunization, screening, disease management guidelines for secondary prevention Diagnosis Suggestions for possible diagnoses that match a patient’s signs and symptoms Planning or implementing treatment Treatment guidelines for specific diagnoses, drug dosage recommendations, alerts for drug-drug interactions Followup management Corollary orders, reminders for drug adverse event monitoring Hospital, provider efficiency Care plans to minimize length of stay, order sets Cost reductions and improved patient Duplicate testing alerts, drug formulary guidelines convenience Delivery of CDS Recommendations to Users Key questions in designing or selecting CDS systems are whose decisions are being supported, what information is presented, when it is presented, and how it is presented to the user. Although it is usually assumed that the physician is the clinician whose decisions are being supported, in some cases it has been found that CDS is more effective if nurses and other 6 clinicians receive the information.26 As for timing, the most effective time to present some kinds of information may be immediately at the point of care—for example, delivering an alert about drug-drug interactions during the prescribing process. Other information, such as the names of patients being seen on a given day who need immunizations, may be less disruptive when delivered prior to the patient encounter. The information from the CDS can be presented automatically to the clinician or “on demand” (i.e., when the clinician chooses to access the information). Whatever the features of CDS delivery of information, the quality of the information and the evidence underlying it are the major determinants of the impact of CDS on patient safety and quality improvement. The description by Osheroff, et al. of what they call the “five rights” of CDS is a good summary of what is needed for effective delivery: CDS should be designed to provide the right information to the right person in the right format through the right channel at the right time (i.e., when the information is needed).18 User Control CDS systems differ in how much control the user has over the decision to use CDS. These decisions involve not only whether the CDS is set up to be displayed on demand, so that users have full control over whether they choose to access it, but also the circumstances under which users can, after viewing the CDS information, choose whether to accept it. The two aspects of control are related and they connect with how closely the CDS advice matches a clinician’s intention. CDS may be designed to (1) remind clinicians of things they intend to do, but should not have to remember; (2) provide information when clinicians are unsure what to do; (3) correct errors clinicians have made; or (4) recommend that the clinicians change their plans. Conceived of in this way, it should be obvious that the users’ reactions to CDS may differ with these diverse intents. An analogy can be seen in some of the functions of common desktop computer applications. When a user employs the calendar functions on the computer, the calendar alarm is an automatically presented reminder of something one intends to do. In this case the automatic notification is one of the most helpful features. The spell checker in a word processing application can both provide advice and correct errors, and can do so while one types (automatically) or after one is finished and the function is accessed to … Get a 10 % discount on an order above $ 100 Use the following coupon code : NURSING10