Evidencebased medicine Clinical decision support systems LIS 4785

Evidence-based medicine; Clinical decision support systems LIS 4785 Introduction to Health Informatics Fall 2015, Week 8 -2 Instructor: Dr. Sanghee Oh

Show and Tell • Winston Jones

Evidence-based Medicine • Evidence-based medicine (EBM) is the process of systematically reviewing, appraising and using clinical research findings to aid the delivery of optimum clinical care to patients. • “The conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients” (Sackett et al. , 1996). • The practice of EBM is the integration of individual clinical expertise with the best available external clinical evidence from systematic research (Sackett et al. , 1996).

CLINICAL DECISION SUPPORT SYSTEM (CDSS)

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Clinical Decision Support System (CDSS) • Computer software that presents uses with ________________________ to enhance healthcare provision and management • Providing ___________________with knowledge and person-specific information, intelligently filtered or presented at appropriate times, to enhance health and health care. • Clinical decision making is based on __________, which is derived from closed clinical trials and sound statistical analysis.

CDSS Components • Encompassing a variety of tools to enhance decision-making in the clinical workflow. These tools include: – computerized alerts and reminders to care providers and patients – clinical guidelines – condition-specific order sets – focused patient data reports and summaries – documentation templates – diagnostic support – contextually relevant reference information among other tools.

Benefits of CDSS • CDSS has a number of important benefits, including: – Increased quality of care and enhanced health outcomes – Avoidance of errors and adverse events – Improved efficiency, cost-benefit, and provider and patient satisfaction

CDSS and Patient Care • ____________: – Communicating with patients; showing empathy and compassion; and being willing to consider the social and psychological factors that could affect a patient’s illness, diagnosis, and treatment. • Micro vs. Macro

CDSS in the Micro Process • The decision process that a physician and her staff face during _________________. • This process might involve _______ encounter, characterized by a persona becoming ill, visiting a physician, receiving treatment, getting well, and leaving the system • CDSS offer _____________at the point of clinical encounter, and that evidence is generated by seasoned researchers in respected health centers. – Standardization & formalization • CDSS can bring accumulated scientific and experiential knowledge, including collegial consultation, to the point of clinical decision making

CDSS in the Macro Process • The clinical decision process for ________________ from numerous physicians and other health professionals who are associated with different healthcare organizations • HIT supports integrating, coordinating clinical activities over time, geographic space (territory), and professional domains (technology). • Health organization and professionals can structure clinical decision-making process around patients, transcending individual professionals and organizations to provide continuity and avoid duplication and gaps

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CDSS & EHR • Different types of CDSS may be ideal for _________ of care in different settings. • The majority of CDSS applications operate as _________, although ___________ are also used.

CDSS & EHR • EHRs, e-prescribing systems, computerized physician order entry, and medication reconciliation systems all are strengthened by some form of clinical decision support. • CDSS should be implemented to an EHR system in order to achieve Meaningful Use Stage 1. • CDSS has been a requirement measure to achieve Meaningful Use State 2 for the improvement of performance on high-priority health conditions. • The resource specification is available from here: – Stage 1: http: //www. cms. gov/Regulations-and. Guidance/Legislation/EHRIncentive. Programs/downloads/11_Clin ical_Decision_Support_Rule. pdf – Stage 2: http: //www. cms. gov/Regulations-and. Guidance/Legislation/EHRIncentive. Programs/downloads/Stage 2 _EPCore_6_Clinical. Decision. Support. pdf

CMS Meaningful Use Regulations • An effort lead by CMS (Centers for Medicare & Medicaid Services) • CMS: Previously known as the Health Care Financing Administration (HCFA), is a federal agency within the United States Department of Health and Human Services (DHHS)

Meaningful Use: 13 Core Objectives 1. Computerized provider order entry (CPOE) 2. Drug-drug and drug-allergy checks 3. Maintain an up-to-date problem list of current and active diagnoses 4. E-Prescribing (e. Rx) 5. Maintain active medication list 6. Maintain active medication allergy list 7. Record demographics 8. Record and chart changes in vital signs 9. Record smoking status for patients 13 years or older 10. Implement clinical decision support 11. Provide patients with the ability to view, download, or transmit their health information online 12. Provide clinical summaries for patients for each office visit 13. Protect electronic health information

CLINICAL PRACTICE GUIDELINES

Clinical Practice Guidelines (CPGs) • _____________ to assist practitioners and patient decisions about health care for specific clinical circumstances • The very best evidence based medical information and formulate an approach to treat a specific disease or condition. • CPGs represent _______ in which evidence is transformed into a recommendation at the point of care. • Many medical organizations use CPGs with the intent to improve quality of care, patient safety and or reduce costs.

CPG Example: Post-Traumatic Stress Disorder (PTSD) Evaluation

Barriers to CPGs • • • Practice setting Contrary opinions ________________, impractical or confusing No uniform level of evidence rating system __________ Excessive influence by drug companies Quality _________

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Web-based CPGs • • National Guideline Clearing House, offered by AHQA, U. S. DHHS National Institute for Health and Clinical Excellence (NICE) Agency for Health Care Research and Quality (AHRQ) Institute for Clinical System Improvement (ICSI)

Setting Standards for Trustworthy CPGs • Establishing transparency; • Management of conflict of interest; • Guideline development group composition; • Clinical practice guideline–systematic review intersection; • Establishing evidence foundations for and rating strength of recommendations; • Articulation of recommendations; • External review; and • Updating. • By IOM, 2011 http: //iom. nationalacademies. org/Reports/201 1/Clinical-Practice-Guidelines-We-Can. Trust. aspx