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Component 6- Health Management Information Systems Unit 5-2 Clinical Decision Support Systems This material was developed by Duke University, funded by.

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Presentation on theme: "Component 6- Health Management Information Systems Unit 5-2 Clinical Decision Support Systems This material was developed by Duke University, funded by."— Presentation transcript:

1 Component 6- Health Management Information Systems Unit 5-2 Clinical Decision Support Systems This material was developed by Duke University, funded by the Department of Health and Human Services, Office of the National Coordinator for Health Information Technology under Award Number IU24OC000024.

2 Objectives Identify the challenges and barriers to building and using CDSSs. Discuss legal and regulatory considerations related to the distribution of CDSSs. Describe current initiatives that will impact the future and effectiveness of CDSSs. Component 6/Unit 5-2 Health IT Workforce Curriculum Version 2.0/Spring 2011 2

3 CDSS Challenges Achievement of the five rights of clinical decision support –Requires communicating the Right information To the right person In the right format Through the right channel At the right time http://healthit.ahrq.gov/images/mar09_cds_book_chapter/CDS_MedMgmnt_ch_1_sec_2 _five_rights.htm Component 6/Unit 5-2 Health IT Workforce Curriculum Version 2.0/Spring 2011 3

4 CDS Five Rights Model Right information –Evidence-based, suitable to guide action, pertinent to the circumstance To the right person –Considering all members of the care team In the right format Through the right channel At the right time http://healthit.ahrq.gov/images/mar09_cds_book_chapter/CDS_MedMgmnt_ch_1_sec_2 _five_rights.htm Component 6/Unit 5-2 Health IT Workforce Curriculum Version 2.0/Spring 2011 4

5 Challenges in Designing or Selecting CDSS Whose decisions are being supported? What information is presented? When is the information being presented? How is the information being presented? http://healthit.ahrq.gov/images/jun09cdsreview/09_0069_ef.html Component 6/Unit 5-2 Health IT Workforce Curriculum Version 2.0/Spring 2011 5

6 User Control User presentation –Automatically –On demand User reaction Component 6/Unit 5-2 Health IT Workforce Curriculum Version 2.0/Spring 2011 6

7 CDS Intent and Key Issues CDS IntentMatch to User’s Intention Key Issues Reminder of actions user intends to do, but should not have to remember (automatic) HighTiming Provide information when user is unsure what to do (on demand) HighSpeed and ease of access Correct user’s errors and/or recommend user change plans (automatic or on demand) LowAutomatic: timing, autonomy and user control over response On demand: speed, ease of access, autonomy and user control over response Component 6/Unit 5-2 Health IT Workforce Curriculum Version 2.0/Spring 2011 7 http://healthit.ahrq.gov/images/jun09cdsreview/09_0069_ef.html

8 Challenges in Building CDSS Impact on Care Process and Patient Health Outcomes –Match of CDS to user intentions –User control, disruptiveness, and risk –Integration of CDS into work processes Impact on Structure http://healthit.ahrq.gov/images/jun09cdsreview/09_0069_ef.html Component 6/Unit 5-2 Health IT Workforce Curriculum Version 2.0/Spring 2011 8

9 Barriers to Using CDSS Acquisition and validation of patient data Modeling of medical knowledge Elicitation of medical knowledge Shortliffe, E., Biomedical informatics: computer applications in health care and biomedicine Component 6/Unit 5-2 Health IT Workforce Curriculum Version 2.0/Spring 2011 9

10 Barriers to Using CDSS Representation of and reasoning about medical knowledge Validation of system performance Integration of decision-support tools Shortliffe, E., Biomedical informatics: computer applications in health care and biomedicine Component 6/Unit 5-2 Health IT Workforce Curriculum Version 2.0/Spring 2011 10

11 Legal Barriers Lack of detailed case laws for CDSS –Which category of law Negligence law Product liability law Shortliffe, E., Biomedical informatics: computer applications in health care and biomedicine Component 6/Unit 5-2 Health IT Workforce Curriculum Version 2.0/Spring 2011 11

12 Legal Barriers Liability borne by –Physicians –Developers of systems Shortliffe, E., Biomedical informatics: computer applications in health care and biomedicine Component 6/Unit 5-2 Health IT Workforce Curriculum Version 2.0/Spring 2011 12

13 Regulatory Barriers Prerelease regulations of medical software Data privacy and security Shortliffe, E., Biomedical informatics: computer applications in health care and biomedicine Component 6/Unit 5-2 Health IT Workforce Curriculum Version 2.0/Spring 2011 13

14 Legislative and Regulatory Efforts Better align efforts across various stakeholders Explore options to establish or leverage a public-private entity to facilitate collaboration Accelerate CDS development and adoption though federal government programs and collaborations http://www.himss.org/content/files/CDSFactSheet3-17-09.pdf Component 6/Unit 5-2 Health IT Workforce Curriculum Version 2.0/Spring 2011 14

15 Future Directions for CDSS ONC initiatives IOM studies Meaningful use objectives and measures Component 6/Unit 5-2 Health IT Workforce Curriculum Version 2.0/Spring 2011 15

16 ONC Initiatives Major activities –Development of a Roadmap for National Action on Clinical Decision Support –Created CDS recommendations –Sponsored a Clinical Decision Support (CDS) Workshop –CDS Government Collaboratory “Advancing CDS” contract –IOM study Component 6/Unit 5-2 Health IT Workforce Curriculum Version 2.0/Spring 2011 16

17 IOM Studies 1999 IOM study –To improve safety, health IT systems should be designed to make it “easy to do the right thing.” 2010 –Launch of a new study on ensuring the efficacy of information technology in improving healthcare safety To err is human: building a safer health system. http://www.nap.edu/openbook.php?record_id=9728 Component 6/Unit 5-2 Health IT Workforce Curriculum Version 2.0/Spring 2011 17

18 Stage 1 Meaningful Use ARRA/HITECH Regulations –Meaningful Use Objectives »Eligible Professional »Hospital Component 6/Unit 5-2 Health IT Workforce Curriculum Version 2.0/Spring 2011 18

19 Summary Challenges and barriers in building and using clinical decision support systems Legal and regulatory barriers in the distribution of these systems Future directions for clinical decision support systems Component 6/Unit 5-2 Health IT Workforce Curriculum Version 2.0/Spring 2011 19

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