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Component 11: Configuring EHRs

Component 11: Configuring EHRs. Unit 3: Clinical Decision Support Lecture 1. Clinical decision support (CDS).

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Component 11: Configuring EHRs

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  1. Component 11: Configuring EHRs Unit 3: Clinical Decision Support Lecture 1

  2. Clinical decision support (CDS) • “Clinical decision support (CDS) provides clinicians, staff, patients, or other individuals with knowledge and person-specific information, intelligently filtered or presented at appropriate times, to enhance health and health care” – AMIA Roadmap (Osheroff, 2007) • Some overviews • Osheroff, 2005 • Greenes, 2007 • Sittig, 2008 • Osheroff, 2009 • Berner, 2009 Health IT Workforce Curriculum Version 2.0/Spring 2011

  3. Why do we need CDS? Quality • There are many studies to choose from… • McGlynn, 2003 • Sample of nearly 7,000 adults in 12 US metro areas assessed for 30 conditions • On average, only 54.9% of care was consistent with known quality • NCQA, 2009 – annual report on quality shows “gaps” to get all health plans to 90th percentile of current quality • 49,400-115,300 avoidable deaths • $12 billion in avoidable medical costs • Quality of care for patients with chronic disease no better and in many ways worse in US than for other developed countries (Schoen, 2009) Health IT Workforce Curriculum Version 2.0/Spring 2011

  4. Why do we need CDS? Safety • The IOM “Errors” report: As many as 98,000 Americans die each year due to medical errors, mostly medication errors (Kohn, 2000) • Some have argued that the numbers are too high or too low, but none argue with the concept • Lost in the discussion: Most errors are the result of faulty systems; the solution is not in making people smarter or punishing them, but building better “systems” to identify and prevent errors (Berwick, 2003) • “Medicine used to be simple, ineffective, and relatively safe. Now it is complex, effective, and potentially dangerous.” (Chantler, 1999) Health IT Workforce Curriculum Version 2.0/Spring 2011

  5. Approaches to CDS covered in this unit • Historical perspectives – focused on diagnosis • More recent approaches – focused on treatment • Reminders – remind clinicians to perform various actions • Alerts – alert clinicians to critical situations • Computerized provider order entry (CPOE) – bringing CDS to the point of care Health IT Workforce Curriculum Version 2.0/Spring 2011

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