Clinical Decision Support: Beyond the Alert
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Transcript of Clinical Decision Support: Beyond the Alert
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Clinical Decision Support: Beyond the Alert
Dean Karavite, MSIRobert Grundmeier, MD
Center for Biomedical Informatics The Children’s Hospital of Philadelphia
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Defining Clinical Decision Support (CDS)
“...the lack of consensus about what is meant by CDS represents a barrier to effective design, implementation, and utilization of CDS tools.”
Three categories of CDS1)“Alerting CDS such as alerts and reminders that fire to deliver information and interrupt workflow”2)“Workflow CDS meant to ease data entry, documentation, and resource location”3)“Cognitive CDS that provides… patient management and planning overview”
CDS can be Explicit or Implicit
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CHOP CBMi “Care Assistant”
Programming framework to enhance our commercial EMR Developed by Dr. Robert Grundmeier and Dr. Alex Fiks
Adds five capabilities to the EMR1. Real time EMR patient data mining2. Integration with expert based rules engine3. Automation of EMR functionality4. Presentation of external content5. New EMR info displays and user interfaces
1. Immunization Assistant2. Asthma Assistant3. Development Assistant4. Short Stature Assistant5. Otitis Media Assistant6. Premature Infant Assistant
In progress1. Shared Decision Making2. Surgical Site Infection3. Genomic Sequencing
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Premature Infant Care
NIH/NLM and AHRQ funding Develop CDS for complex
patients Support primary care in
premature infant care for first two years of life
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Preemie Assistant: Patient Summary
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Preemie Assistant: Growth/Nutrition
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Preemie Assistant: Summary
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AAP RSV-Synagis Policy Statement
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AAP RSV-Synagis Rules
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RSV-Synagis Workflow
Nurses can spend 10-20 hours per patient managing this workflow over 6 months
Some practices have over 50 patients to manage1/8 to 1/4 Nursing FTE
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Expanded CDS Requirements
Traditional CDS One patient at a time At the point of care Limited workflow support
to one encounter or admission
RSV-Synagis CDS All patients at once 1-2 months in advance 6 month workflow across multiple encounters
RSV-Synagis not unique: Management of leuprolide to delay puberty Tracking patients for ROP …
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“The Synagis Binders”
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RSV Assistant for Nurses
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RSV-Synagis Patient List
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Results
83% received at least one dose by 12/31 compared to 77% prior year Socio-economics a major factor in outcomes
RSV Assistant can eliminate patient information in shadow charts Clinic with most Synagis patients in entire network
Building consensus on RSV-Synagis Pediatric Academic Societies presentation
tomorrow CHOP specialists and others presented
statements to CDC for more rigorous Palivizumab trials
GLIDES reporting downstream impact of ambiguous language to guideline authors
Waning Shadows?
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Questions/Comments?
Preemie Assistant TeamPrimary Care Experts
Dr. Alex Fiks, Dr. Robert Grundmeier, Dr. Annique HoganPremature Infant Experts
Dr. Judy Bernbaum, Jo Ann D'Agostino DNP, CRNP, Dr. Trude Haecker, Dr. Hallam Hurt, Dr. Scott Lorch Developers
Le Mar Davidson, Dr. Robert Grundmeier, Jeff Miller, Byron RuthData Analyst
Mark RamosStudy Coordination/Administration
James Massey, Valerie McGoldrick, Kelli Wynn-MooreStatisticians
Russell Localio PhD, Lihai Song
GLIDES Dr. Jeremy Michel, Dr. Richard Shiffman
Additional SupportInformation Services
David Krill, Raja Pudivenkata, Chris Qaddoumi, Linda TagueCHOP practices contributing to system development activities
Chestnut Hill, Faculty Practice, Market Street, Paoli