Va Decision Support Seminars 2009

Decision Support in VA Clinical Information Systems James L. Breeling, MD March 18, 2009 BU Informatics Series

Diffusion of Innovations ,[object Object],[object Object],[object Object]

Clinical Knowledge is a Special Case ,[object Object],[object Object],[object Object],[object Object],[object Object]

Unexplained Practice Variation

Business Drivers for Evidence Based Medicine ,[object Object],[object Object],[object Object]

Guideline Implementation VHA ORD HSR&D Blueprint for Change Jan 26, 2000 Practices or Strategies Definition Organizational & Administrative Changes in Leadership, responsibility, policy, decision making, culture, knowledge management, communication and coordination Technology & Infrastructure Changes in information technology, data management, feedback, physical plant and equipment Care Delivery Changes in care delivery process, patient interactions, patient education, clinical programs and treatment analysis Staff Resources & Development Changes in resource allocation, increased awareness and knowledge, skill building, influence provider attitude, behavior changes.

Expansion of Medical Knowledge ,[object Object],[object Object]

Clinical Decision Support Challenges ,[object Object],[object Object],[object Object]

Facets of Clinical Decision Support ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Pitfalls of Clinical Decision Support ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Knowledge Life-Cycle Proposed Guideline & Content Guideline Defined & Validated Functional Knowledge Specified for Encoding Engineered into Production Ongoing Revisions & Eventual Sunset

VISTA Clinical Reminder Package: Designing a Reminder ,[object Object],[object Object],[object Object],[object Object]

VISTA Clinical Reminders: Findings ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Boolean Logic: How Findings Are Used to Define Populations A AND NOT B A B A AND B A B A OR B A B The negation of “A or B” is “Not A and not B” The negation of “A and B” is “Not A or not B”

Importance of Denominators ,[object Object],[object Object],[object Object]

Two Difference Populations Receiving Pneumovax ,[object Object],[object Object],[object Object],[object Object]

Pneumovax Example: Denominators # Patients with Reminder Applicable Reminder Due ------------------- ------------ 1 Pneumovax 33 11 # Patients with Reminder Applicable Reminder Due ------------------- ------------ 2 Pneumovax 19 11 45 patients evaluated

Dialogs: What Is in the Programming Tool Box? ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Dialogs – Informatics Ergonomics ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Applications ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Patient Lists ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Clinical Reminders – Network Initiative and Governance ,[object Object],[object Object],[object Object],[object Object],[object Object]

Clinical Decision Support ,[object Object],[object Object],[object Object],[object Object],[object Object]

Clinical Decision Support ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Principle 1: If the Information Is Necessary, It Should Be Made Known Before Any Action ,[object Object],[object Object],[object Object]

Principle 2: Intrusiveness is more tolerable when the situation is more complex ,[object Object],[object Object],[object Object]

The CPR in US Industry: Gartner Group (1999) Functionality First Generation: The Collector 1993 1998 2003 2008 2012+ Second Generation: The Document Fourth Generation: The Partner Fifth Generation: The Mentor Minimal Full Predicted Marketplace Maturity Data Acquired Through Feeder Systems Document Care in Free Text Structured Documentation Spanning Episodes of Care Clinical Workflow Intervention Screening Decision Support Automated Generation Of Pathways and Workflow; Use by Consumers Now Third Generation: The Helper

Va Decision Support Seminars 2009

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