Upload
lisa-fields
View
217
Download
0
Tags:
Embed Size (px)
Citation preview
Achieving Meaningful Clinical Decision Support in a Medical Home
JEROME A OSHEROFF, MD, FACP, FACMICHIEF CLINICAL INFORMATICS OFFICER, THOMSON REUTERSFACULTY/STAFF, UNIVERSITY OF PENNSYLVANIA
PCPCC ConferenceMarch 30, 2010
©20
09 T
hom
son
Reu
ters
PCMH & CDS: MEANS TO AN END
Measurably Improve Quality/Safety/Cost/ Efficiency/Satisfaction
• Accreditation
• Reimbursement– Value-based Purchasing/non-payment
– Transparency/Accountability
– Meaningful Use
Drivers are Intensifying and Consolidating!
©20
09 T
hom
son
Reu
ters
“QUALITY/SAFETY” TARGETS*
3
* From meaningful use NPRM
©20
09 T
hom
son
Reu
ters
EHR ≠ QUALITY
©20
09 T
hom
son
Reu
ters
PERFORMANCE IMPROVEMENT:A SYSTEMATIC APPROACH
Select/ Prioritize Targets
(MU/Analytics)
Measure Baselines, Benchmark
Develop Improvemen
t Plans
Execute Improvement
s (CDS)
Re-measure
5
©20
09 T
hom
son
Reu
ters
CDS DEFINITION
6
“…provide persons involved in care processes with general and person-specific information, intelligently filtered and organized, at appropriate times, to enhance health and health care” – from MU NPRM
Includes/builds on current processes…
NOT just rules and alerts…
©20
09 T
hom
son
Reu
ters
GUIDANCE ON GETTING CDS RIGHT
• Co-published 4/09 by leading societies; ~100 contributors
• 2009 HIT book of the year
• Co-sponsors include AHRQ, 3 CIS vendors
• “This is not a book”
• 2005 HIT book of the year
• All-time HIMSS bestseller
• Widely used by CMIOs/others
• 10 commandments for CDS: Bates et al. JAMIA 2003
• CDS: the road ahead. Greenes ed. Elsevier 2007
HIMSS Others
©20
09 T
hom
son
Reu
ters
A FORMULA FOR SUCCESS:THE CDS FIVE RIGHTSTo improve care outcomes with CDS you must provide:
• the Right Information…Evidence-based, useful for guiding action and answering questions
• …to the Right Stakeholder…Both clinicians and patients
• …in the Right Format…Alerts, Order Sets, answers, etc.
• …through the Right Channel…Internet, mobile devices, clinical information systems
• …at the Right Point in the Workflowto influence key decisions/actions
©20
09 T
hom
son
Reu
ters
9
CDS INTERVENTION TYPES
• Relevant data presentation: flowsheets, surveillance
• Order creation facilitators: order sentences, sets
• Reference information: infobuttons, Web
• Unsolicited alerts: proactive warnings
• Documentation templates: patient history, visit note
• Protocol support: pathways
©20
09 T
hom
son
Reu
ters
Workflow Opportunities
©20
09 T
hom
son
Reu
ters
CDS PEARLS FOR MEDICAL HOMES
1. Consider CDS Basics– Define CDS broadly
– Consider CDS 5 Rights
2. Establish Foundation– Select/prioritize targets
– Establish baselines
3. Consider Workflow
4. Optimize CDS in Available Systems– EHR, Portal, Registry, Practice Management…
©20
09 T
hom
son
Reu
ters
CDS PEARLS FOR MEDICAL HOMES
5. Optimize CDS for Specific Targets – Workflow analysis/CDS 5 Rights=alert fatigue antidote
6. Deploy for Max Acceptance & Value– Fully engage staff/patients
7. Measure Effects and Refine Program – Do it! (Examine intended/unintended effects; enhance)
8. Manage Knowledge Assets/Processes – Approach proactively, systematically
©20
09 T
hom
son
Reu
ters
THANK YOU!
Resources• PCPCC
– Meaningful Use Meaningful Connections: http://www.pcpcc.net/content/meaningful-connections-it-resource-guide
• HIMSS Clinical Decision Support Guides– www.himss.org/cdsguide
• HIMSS CDS Task Force (VTE and Meaningful Use Projects)– http://himssclinicaldecisionsupportwiki.pbworks.com
• Jerry Osheroff– [email protected]