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Explore the potential of clinical decision support in improving healthcare quality and effectiveness at the point of care. Identify opportunities to provide essential information for clinicians and patients alike, using system-initiated alerts, reminders, reference databases, and more.
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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
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.
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.
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
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
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