EMR optimisation with clinical decision support August 2019 Ian - - PowerPoint PPT Presentation
EMR optimisation with clinical decision support August 2019 Ian Z. Chuang, MD, MS, CCFP Ian Z. Chuang, MD, MS, CCFP Chief Medical Officer, Elsevier Health, International Clinical Experience: Licensed Family Physician Previously,
August 2019 Ian Z. Chuang, MD, MS, CCFP
Chief Medical Officer, Elsevier Health, International
Clinical Experience:
Healthcare Informatics:
Cigna
eMR adoption in Australia
eMR vendors in Australia
Intersystems, Emerging
Actual stage of eMR
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Some known challenges with EHRs
− Significant resource needed to build and maintain in house − Lack of governance − Low compliance / clinician dissatisfaction − Lack of template consistency leading to inefficiencies − Non-evidence based or lack of supporting evidence
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Efficiency Quality Safety Cost Effectiveness/ Value Access
clinical decision flow
− Productivity through data flow and automation − Transaction reliability − Care delivery efficiency
− Clinical decision consistency and optimization (evidence, guideline, patient) − Clinical decision reliability − Physician workflow efficiency
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Clinical Decision Support is a process for enhancing health-related decisions and actions with pertinent, organized clinical knowledge and patient information to improve health and healthcare delivery. Information recipients can include patients, clinicians and others involved in patient care delivery information delivered can include general clinical knowledge and guidance, intelligently processed patient data, or a mixture of both; and information delivery formats can be drawn from a rich palette of
alerts, and others.
Improving outcomes with clinical decision support: an implementer’s guide. Second Edition. HIMSS 2012.
“Order sets… have the potential to be among the most impactful forms of clinical decision support (CDS). Ideally, they are deeply embedded in the EMR and have the
KLAS, Clinical Decision Support 2012. www.klasresearch.com
What is Clinical Decision Support?
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Stone Executive in Charge, Veterans Health Administration
“This implementation of the EHRM is forcing us to address programmed variation in care and define the VA standard of care, and we will lead in the USA.
Challenge - Variation & inappropriate ordering
Some commonly over-ordered or inappropriately ordered tests include:
ventilated-patients-despite-guidelines/)
medical-errors-killing-one-of-every-five-australians
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Inappropriate ordering
report on Antimicrobial Use and Resistance in human health
prescriptions for surgical prophylaxis that extended beyond the recommended 24 hours dropped from 41.1% in 2013 to 30.5%
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safetyandquality.gov.au/AURA2019
Thyroid function
“Current guidelines recommend thyroid stimulating hormone (TSH) alone as the best test to detect and monitor thyroid dysfunction, yet free thyroxine (FT4) and free triiodothyronine (FT3) are commonly ordered when not clinically indicated. Excessive testing can lead to added economic burden in an era of rising healthcare costs, while rarely contributing to the evaluation or management of thyroid disease.”
Kluesner, JK, Beckman, DJ, Tate, JM, et al. Analysis of current thyroid function test ordering practices. J Eval Clin Pract. 2018; 24: 347– 352. https://doi.org/10.1111/jep.12846
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Imagine being a first year resident on your first day in the emergency department of a busy city hospital – and you are on your own due to an influx of patients. A patient arrives via ambulance with suspected pneumonia. The nurses have done their observations, put an IV line in and begun O2 via a face mask. They are waiting for you to
You enter a provisional diagnosis of pneumonia within the patient record and then begin to order medications and labs BUT you haven’t had to do this before and all of the senior doctors are busy. You start to order blood cultures, but the clinical decision support advisory notes the blood cultures should be avoided in patients who are not systemically septic, have a clear source of infection and in whom a direct specimen for culture (e.g. urine, wound swab, sputum, cerebrospinal fluid or joint aspirate) is possible.1
Solution – Embedded evidence can guide appropriate ordering
Solution – Embedded evidence can guide appropriate ordering
Solution – Embedded evidence can guide appropriate ordering
User Feedback on Quality (300 responders)
User Feedback on Evidence (300 responders)
User Satisfaction (300 responders)
Reduction in unnecessary and inappropriate tests leads to organisational financial gains WITHOUT compromising patient care Education of clinicians on the cost of tests leads to a decrease of inappropriate orders, unnecessary orders and repeat
A study completed at GCUH found that these tests are frequently ordered with little consideration of purpose or intent:
Education of clinicians and the use of Order Sets realised a marked decrease in over and unnecessary ordering of these tests
0Path%20Ording%20NCOPP.pdf
Challenge – Clinician Productivity
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https://www.healthcareittoday.com/2015/07/08/survey-physician- ehr-satisfaction-and-ehr-productivity/
One potential cause – inefficient ordering
searching for orderable items
satisfy every possible option
clinician preference
Usability Metrics: Human Computer Interaction
CDS Metrics
Challenge – Order Set Development Process
so previous discussions are remembered
Carotid Stenosis Carotid Stent Carotid Endarterec- tomy Neuro Surgeon CT NIR Cardiologist Vascular
with separate tabs for each organisation’s content
even tabs for other organisations in ANZ or worldwide that have agreed to share content with you
Health Service 1 Health Service 2 Health Service 3
Add linked guidance from the Elsevier library Manage
specific advisories and guidelines
re-organise using drop and drag
Solution – Templated Order Sets
associated with your orders and choices associated with each field
details available that are in your EMR, in your terminology
Solution – Templated Order Sets
Solution – Templated Order Sets
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1 2 3 4 5 6 7 8 9 10 Analyst manual build Elsevier order sets build
Hours
Analyst time spent to build one order set
Visit us at booth number 49 to find out more or discuss our clinical decision support and other products: Tim Hawkins (MD, Elsevier Clinical Solutions) Terry Reece (ANZ Head of Clinical Solutions) Angie List (ANZ Head of Sales) Lis Herbert (Clinical Informatics Manager) Colin McNeil (Product Manager)
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