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Clinical Decision Support in a Medical Home

Clinical Decision Support in a Medical Home. Donna M. D’Alessandro, M.D. donna-dalessandro@uiowa.edu. An Overview. Coming Soon!. PCPCC’s White Paper on Clinical Decision Support in the Medical Home. What is Clinical Decision Support (CDS)?.

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Clinical Decision Support in a Medical Home

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  1. Clinical Decision Support in a Medical Home Donna M. D’Alessandro, M.D. donna-dalessandro@uiowa.edu An Overview

  2. Coming Soon! • PCPCC’s White Paper on Clinical Decision Support in the Medical Home

  3. What is Clinical Decision Support (CDS)? • CDS is defined as providing clinicians or patients with clinical knowledge and intelligently-filtered [appropriate or key] patient information to enhance patient care. • Healthcare Information and Management Systems Society Fact Sheet • CDS delivers information that is highly relevant to the current situation, and then is presented for the most effective use.

  4. Health Information Technology Needs CDS • HIT in isolation will not lead to improvements in quality/ efficiency - it needs CDS. Neonatal Jaundice

  5. The 5 Right’s of CDS • The goal of CDS is to provide: • The Right information • to the Right person • in the Right format • through the Right channel • at the Right point in clinical workflow

  6. CDS interventions can: • Detect potential safety and quality problems and help prevent them • Drug/drug interactions, allergies • Foster the greater use of evidence-based medicine principles and guidelines • Detect inappropriate utilization of services, medications, and supplies

  7. CDS interventions can: • Organize, optimize and help operationalize the details of a care plan • Help gather and present data needed to execute this plan

  8. CDS Interventions Can: • Ensure that the best clinical knowledge and recommendations are utilized to improve health management decisions by clinicians and patients

  9. CDS Categories • Structured Templates/Checklists (may already be used in paper form) • Order Sets • Alerts/Reminders • Algorithms/Protocols

  10. CDS Categories • Links / infobuttons to online resources/reference information • Evidence-based clinical guidelines • Online risk-assessment calculators • Online textbooks/educational resources – pathology lab testing book • Patient data reports, graphs and charts to display change in metrics over time (eg, Hba1c, blood pressure) - BMI is automatically calculated too !

  11. What are the potential problems of CDS? • Poor integration with physician workflow – stand alone applications • Alert fatigue – too many and intrusive • Can’t act immediately on suggested actions

  12. What are the potential problems of CDS? • Can’t act immediately on suggested actions

  13. What are the potential problems of CDS? • Clinical frustration • “Cookbook medicine” • Change in workflows/extra steps/unproven value • Pressure to implement decision support based on limited evidence – not enough data available to act upon

  14. Decision Support in the Medical Home • Requirements - National Committee for Quality Assurance • Requirements - “Meaningful Use” • Drug-drug, drug allergy, drug formulary checks • Send reminders to patients for preventive care • Implement 5 CDS rules relevant to specialty or high clinical priority • More requirements and recommendations

  15. For More Information: • Health Information and Management Systems Society http://www.himss.org • Agency for Healthcare Research and Quality http://healthit.ahrq.gov (Knowledge Library)

  16. CDS is all about Healthy Patients and Families

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