Running Head: ELSEVIER CLINICAL DECISION SUPPORT 1

Running Head: ELSEVIER CLINICAL DECISION SUPPORT 1

Elsevier Clinical Decision Support

Melanie Serafine

Excelsior College

March 2, 2014

ELSEVIER CLINICAL DECISION SUPPORT 2

Executive Summary

Meaningful use is a growing need in healthcare organizations and is the way that Electronic

Health Record (EHR) technology is used to improve quality, safety and efficiency, engage

patients & families, improve care coordination and public health, and maintain security and

patient privacy (Hanrahan, 2013). Elsevier Decision Support System (DSS) provides support for

responsible care, reporting, medication reference, decision support, evidence-based practice

guidelines, evidence-based reference, care planning and documentation, learning and

performance supervision, nursing reference, nursing skills and procedures, patient education, and

compliance for ICD-10 coding (Elsevier, 2014a; Elsevier, 2014b). Two components of this DSS

are the care plans & clinical documentation module, CPMCarePoints, and the nursing skills &

procedures module for clinical decision making (Elsevier, 2014a; Elsevier, 2014b). The

advantages that these modules will have on the nursing department are numerous and can be

implemented to improve the quality of patient care and nursing competency. The Nursing Skills

& Procedures module uses Mosby’s Nursing Consult and Mosby’s Skills to present tools for best

practice and nursing education resources (Elsevier, 2014a). Using this module will enable

nursing staff to perform nursing actions universally and increase total competency, and keep staff

informed of policy and organizational changes (Elsevier, 2014a). CPMCarePoints provides tools

to allow clinicians to guide evidence-based subject matter, and presents nursing guidelines to

improve the care planning and documentation processes (Elsevier, 2014b). This minimizes

variance while improving patient care outcomes (Elsevier, 2014b). CPMCarePoints transforms

the practice model, supports clinical measures, has tools for quality care, and provides evidence

based workflows (Elsevier, 2014b), benefiting nursing personnel in hospitals and in home care

agencies.


Elsevier Clinical Decision Support

Description

Elsevier Clinical Solutions is based in Amsterdam and it is a company that offers access

to healthcare information to much of the world (Elsevier Clinical Solutions, 2014). It can be

found on the web via the website http://www.clinicaldecisionsupport.com. From here, one can

read about Elsevier and browse the clinical solutions, media center, partners, or contact the

company directly (Elsevier Clinical Solutions, 2014). Elsevier oversees 25% of the clinical and

scientific content in the world and assists over 20 million healthcare professionals (Elsevier

Clinical Solutions, 2014).

Problem Analysis & Solutions

Decisions in many healthcare environments must be made immediately, and when

healthcare professionals combine their experience and prior knowledge with Clinical Decision

Support (CDS) Systems, treatment that is specific to the situation can be delivered with an

expertise that improves patient outcomes and care delivery (Capot & Bert, 2013). Facing the

demand for improving care, and delivery of that care, has been a challenge facing all healthcare

organizations for years, and was addressed in the 2005 book, written by Dr. Jonathan Teich, MD,

PhD, entitled Improving Outcomes with Clinical Decision Support: An Implementer’s Guide

(Capot & Bert, 2013). As nurses contend with the ever-changing needs of patients in diverse

environments, care planning, clinical documentation, nursing skills and clinical procedures that

are readily available on the spot will contribute to reaching the goals set out above.

CPMCarePoints Functional Components and Product Use

CPMCarePoints is a care planning and documentation system that is installed into an

existing Electronic Health Record (EHR), and provides evidence-based clinical practice

guidelines for medical, surgical and human response diagnoses (Elsevier, 2014b). The

http://www.clinicaldecisionsupport.com/


implementation and integration of this module has a timeframe of a few months and can be pre-

built prior to installation (Elsevier, 2014b). Its functional components consist of automated

electronic documentation tools, dispersing care sets that customize documentation (Elsevier,

2014b). The risk screens and scales within the module make information readily available, and

CPMCarePoints is truly interdisciplinary, able to be used not only by nurses, but also dieticians,

physical therapists, respiratory therapists, and other members of the team (Elsevier, 2014b).

There are a variety of content collections with the CarePoint system, including inpatient acute

care, pediatrics, obstetrics, critical care, and newly available, emergency care (Elsevier, 2014b).

Since CPMCarePoints is integrated into an existing EHR, it would be stored onto

whichever system the organization is currently utilizing. A client-server system would be

beneficial, allowing for smaller databases to be set up for each discipline, which communicates

with the main server, thereby decreasing computer wait time for end users.

Meaningful use has also been considered with CPMCarePoints. One of the key

objectives for The American Recovery and Reinvestment Act (ARRA) is to improve the quality

of patient care and reduce variance in that care (CDC, 2014). With the use of CPMCarePoints,

healthcare providers will be better equipped to meet the meaningful use guidelines set forth for

reporting, consistency of care, and improved outcomes (Elsevier, 2014b). CPMCarePoints can

be found on the web at http://www.cpmrc.com/solutions/cpm-carepoints/.

Nursing Skills and Procedures Module Functional Components and Product Use

The nursing skills and procedures module uses Mosby’s Nursing Consult and Mosby’s

Skills to provide clinical information and a skills and procedures reference that go hand in hand

in delivering nursing care (Mosby’s Suite, 2014a; Mosby’s Suite, 2014b). Both modules afford

evidence-based guidelines for practice, and cover many clinical areas such as critical care,

general, pediatrics, emergency, mental health, oncology and more (Mosby’s Suite, 2014a;

http://www.cpmrc.com/solutions/cpm-carepoints/


Mosby’s Suite, 2014b). Furthermore, Mosby’s Skills has specifically partnered with the

American Association of Critical Care Nurses (AACN), the Association of Women’s Health,

Obstetrics, and Neonatal Nurses (AWHONN), and the American Society for Parenteral and

Enteral Nutrition (A.S.P.E.N.) to develop and review content (Mosby’s Suite, 2014a).

Both modules deliver information at the point of care using web-based search tools to

answer nursing questions for reference and skill instruction (Elsevier Clinical Solutions, 2014).

Mosby’s Skills and Mosby’s Nursing Consult can be found on the web at

http://confidenceconnected.com/products/mosbys_skills/overview/ and

http://www.confidenceconnected.com/products/mosbys_nursing_consult/overview/ respectively.

Agency Utilization

CPMCarePoints, Mosby’s Skills and Mosby’s Nursing Consult have all been designed

for unit specific integration within the hospital system. However, since CPMCarePoints can be

built and installed into a current EHR, its utilization could theoretically be expanded for use in

home care, outpatient clinics and doctor’s offices (Elsevier, 2014b; Mosby’s Suite, 2014a;

Mosby’s Suite, 2014b). When deciding to implement a new DSS, or upgrade a current one, a

Project Team is developed who is responsible for planning and implementing the project

(CPMM, 2013). This team consists of an Executive Sponsor, Project Sponsor/Directors,

Steering Committee, Project Manager, Team Members and Customers (CPMM, 2013). The

roles and organizational positions held are presented in table 1.

http://confidenceconnected.com/products/mosbys_skills/overview/

http://www.confidenceconnected.com/products/mosbys_nursing_consult/overview/


Project Role Scope of Authority Organizational Title

Executive Sponsor Secures spending authority and project

resources, legitimizes project goals and

objectives. The ultimate decision maker

for the project.

Vice President for

Information Technologies

Project Sponsor/Directors Participate in and/or lead project

initiation, assists in securing spending

authority and project resources,

legitimizes project goals and objectives.

VP of Nursing Services

Director, Information

Systems

Steering Committee Acts individually and collectively as a

vocal and visible project champion

throughout their representative

organizations; generally they approve

project deliverables, help resolve issues

and policy decisions, approve scope

changes, and provide direction and

guidance to the project.

Nursing Executive Steering

Committee- representatives

from nursing units and

representatives from the

performing organization

Project Manager Ultimately responsible for ensuring that

the Project Team completes the project

by developing the Project Plan and

managing the team’s operation.

Involved in the communication, status

reporting, risk management, problem

escalation, and remaining within budget

parameters.

Senior Project Manager for

Administrative Systems

IT Integrations Manager

Nursing Informaticist

Team Members Technical Managers

Functional Mangers

Program analysts, business analysts,

content experts, data delivery experts,

and consultants.

These personnel are from

different areas of the

organization or are outside

consultants.

Customers Comprise the business units that

identified the need for the product or

service the project will develop

Customers can be at all

levels of an organization

including customer

representatives and customer

decision-makers.

Table 1. Project Team. (CPMM, 2013).

The enhancement of systems and integration of upgrades, including embedded decision

support systems and EBPs into the clinical processes of an organization necessitates risk analysis

and planning. As the Project Team analyzes and tests the DSS, its communication, and security

and privacy, issues should become evident. To date, no communication, or security and privacy

issues with CPMCarePoints, Mosby’s Skills or Mosby’s Nursing Content have been reported.


Product Integration

Mosby’s Skills and Mosby’s Nursing Consult

Mosby’s Skills and Mosby’s Nursing Consult are 100% web-based. The capture and

communication is provided via an imbedded link to the working module (Mosby’s Suite, 2014a;

Mosby’s Suite, 2014b). After login, nurses are presented with a search option for evidence-

based answers to nursing content or instructions for nursing skills (Mosby’s Suite, 2014a;

Mosby’s Suite, 2014b). Due to its internet based nature, there are no permanent storage

requirements and it is available at all times. The evidence based practice information presented

is acquired and examined by professional nursing associations to ensure accurate and up to date

information related to nursing best practices (Mosby’s Suite, 2014a). See figures 1, 2 and 3 to

view Mosby’s Skills and Mosby’s Nursing Consult.

Figure 1. Mosby’s Skills. (Mosby’s Suite, 2014a).


Figure 2. Mosby’s Skills. (Mosby’s Suite, 2014a).

Figure 3. Mosby’s Nursing Consult. (Mosby’s Suite, 2014b).

CPMCarePoints

The framework for CPMCarePoints is all inclusive to an existing EHR built directly into

a current operating system (Elsevier CPM Resource Center, 2014). It is an interoperable

database, therefore, storage and processing is integrated into the EHR (Elsevier CPM Resource


Center, 2014). This DSS can be pre-configured with current systems to streamline presentation,

reporting and availability (Elsevier CPM Resource Center, 2014). See figures 4, 5 and 6 to view

screenshots of CPMCarePoints.

Figure 4. Integrated Patient Documentation. (Elsevier CPM Resource Center, 2014).

Figure 5. CPMCarePoints. (Elsevier CPM Resource Center, 2014).


Figure 6. Point of Care Guidelines. (Elsevier CPM Resource Center, 2014).

Conclusion

The collection and meaningful use of data is essential for administrative, research and

clinical decision making (Turban, Sharda, Delen, Aronson, Liang, & King, 2011). The essence

of decision making lies in the process of choosing a best course of action to achieve a desired

goal (Turban et al., 2011). Goals in healthcare are increasingly based upon quality, safety and

improved patient outcomes. Therefore, choices that are made to achieve these goals should be

based on information that is safe, accurate and of high quality. This is best accomplished with

integrating evidence-based practice information and solutions into nursing practice decision

support systems. The decision support offered by Elsevier includes the most up to date and

cutting edge technology available around the world, with the coordination of professional

nursing associations for best practice guidelines (Elsevier, 2014a; Elsevier, 2014b). The

implementation of integrated DSS and the use of web-based technologies is a tool that healthcare

cannot afford to under-utilize. By employing CPMCarePoints into current EHRs, and utilizing

Mosby’s Nursing Skills and Mosby’s Nursing Consult, organizations will have all the available


tools to increase quality nursing care, enhance patient safety, improve clinical outcomes, ensure

regulatory compliance, reduce variability, increase the efficiency of staff and meet ARRA

Meaningful use requirements (CDC, 2014; Elsevier, 2014b; Mosby’s Suite, 2014a; Mosby’s

Suite, 2014b).


References

Capot, C., & Bert, A. (2013). They wrote the book (of the year) on clinical decision support: Dr.

Jonathan Teich talks about CDS after top award from HIMSS. Retrieved from

http://www.elsevier.com/connect/they-wrote-the-book-of-the-year-on-clinical-decision-

support

Centers for Disease Control and Prevention (CDC). (2014). Meaningful use. Retrieved from

http://www.cdc.gov/ehrmeaningfuluse/

Cornell Project Management Methodology (CPMM). (2013). Project roles and responsibilities.

Cornell University. Retrieved from

http://www2.cit.cornell.edu/computer/robohelp/cpmm/Project_Roles_and_Responsibiliti

es.htm

Elsevier. (2014a). Nursing skills and procedures. Retrieved from

http://www.clinicaldecisionsupport.com/nursing-skills-and-procedures

Elsevier. (2014b).CPMCarePoints. Retrieved from http://www.cpmrc.com/solutions/cpm-

carepoints/

Elsevier Clinical Solutions. (2014). About Elsevier. Retrieved from

http://www.clinicaldecisionsupport.com/about

Elsevier CPM Resource Center. (2014). Elsevier CPM resource center to integrate

comprehensive evidence-based clinical documentation tools into EHR at Medcenter One.

Retrieved from http://www.cpmrc.com/2011/09/medcenterone_pressrelease_091211/

Hanrahan, D. (2013). Data mining, meaningful use, secondary use, and potential misuse of

electronic health records. Ethical Technology. Retrieved from

http://ieet.org/index.php/IEET/more/hanrahan20131115


Mosby’s Suite. (2014a). Mosby’s skills: Perform skills and procedures with confidence.

Retrieved from http://confidenceconnected.com/products/mosbys_skills/overview/

Mosby’s Suite. (2014b). Mosby’s nursing consult: Bringing best practices to the bedside.

Retrieved from

http://www.confidenceconnected.com/products/mosbys_nursing_consult/overview/

Turban, F., Sharda, R., and Delen, D., Aronson, J.E., Liang, T.P., & King, D. (2011). Decision

support and business intelligence systems. (9th ed.). Upper Saddle River, NJ: Prentice

Hall.

Documents

Running Head: ELSEVIER CLINICAL DECISION SUPPORT 1