Clinical Decision Support at the Point of Care

1. Clinical Decision Support at the Point of Care Dean F. Sittig, Ph.D. Kaiser Permanente Jerry Osheroff, M.D., Micromedex HL-7 Working Meeting San Antonio, TX

2. Goal • Identify and develop a shared understanding of the opportunities to enhance the quality and effectiveness of health care by providing clinical decision at the point of care.

3. Simplifying Assumptions • Basic structure of decision support needs are basically similar for in-patient, out-patient and emergency department settings. • Current focus is on helping clinicians, but future work could be done for patients or administrators.

4. Decision Support Opportunities • Workflow stage: • diagnostic / management essentials to refresh clinician’s memory before, during or after visit also information for patient education • System - facilitated: • context-specific links to reference db • System - initiated: • [alerts/reminders about impending quality issues, e.g. omission/commission errors], automatically generated, patient-specific “ToDo” list - Arden rules

5. Decision Support Opportunities • Workflow stage: • Need to fully characterize and document patient condition or provide a safety net • System - facilitated: • documentation templates, order sets • System - initiated: • drug-drug & drug-allergy interaction checking, corollary orders

6. Classes of Clinical Decision Support • Reference Databases - clinician and patient education • Drug formulary, drug-drug and drug-allergy interactions, corollary orders • Problem-specific order sets and documentation templates • Clinical alerts and reminders - Arden rules • Guidelines - therapy mgmt, test interpretation • Diagnostic aids - differential diagnosis