1. Evidence-based medicine; Clinical decision support systems
LIS 4785 Introduction to Health Informatics
Fall 2015, Week 8-2
Instructor: Dr. Sanghee Oh

2. Show and Tell
Winston Jones

3. Evidence-based Medicine
Evidence-based medicine (EBM) is the process of systematically reviewing, appraising and using clinical research findings to aid the delivery of optimum clinical care to patients.
“The conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients” (Sackett et al., 1996).
The practice of EBM is the integration of individual clinical expertise with the best available external clinical evidence from systematic research (Sackett et al., 1996).

4. Clinical Decision Support System (CDSS)

5. VisualDx https://www.youtube.com/watch?v=j8fCpEaiGA4

6. Clinical Decision Support System (CDSS)
Computer software that presents uses with ________________________________________________ to enhance healthcare provision and management
Providing ______________________________________with knowledge and person-specific information, intelligently filtered or presented at appropriate times, to enhance health and health care.
Clinical decision making is based on ___________________, which is derived from closed clinical trials and sound statistical analysis.

7. CDSS Components
Encompassing a variety of tools to enhance decision-making in the clinical workflow. These tools include:
computerized alerts and reminders to care providers and patients
clinical guidelines
condition-specific order sets
focused patient data reports and summaries
documentation templates
diagnostic support
contextually relevant reference information among other tools.

8. Benefits of CDSS CDSS has a number of important benefits, including:
Increased quality of care and enhanced health outcomes
Avoidance of errors and adverse events
Improved efficiency, cost-benefit, and provider and patient satisfaction

9. CDSS and Patient Care ________________________:
Communicating with patients; showing empathy and compassion; and being willing to consider the social and psychological factors that could affect a patient’s illness, diagnosis, and treatment.
Micro vs. Macro

10. CDSS in the Micro Process
The decision process that a physician and her staff face during _________________________________.
This process might involve _______ encounter, characterized by a persona becoming ill, visiting a physician, receiving treatment, getting well, and leaving the system
CDSS offer _________________________at the point of clinical encounter, and that evidence is generated by seasoned researchers in respected health centers.
Standardization & formalization
CDSS can bring accumulated scientific and experiential knowledge, including collegial consultation, to the point of clinical decision making

11. CDSS in the Macro Process
The clinical decision process for _______________________________ from numerous physicians and other health professionals who are associated with different healthcare organizations
HIT supports integrating, coordinating clinical activities over time, geographic space (territory), and professional domains (technology).
Health organization and professionals can structure clinical decision-making process around patients, transcending individual professionals and organizations to provide continuity and avoid duplication and gaps

12. VisualDx Tutorial 01: Basic Search

13. CDSS & EHR
Different types of CDSS may be ideal for __________________ of care in different settings.
The majority of CDSS applications operate as _________________, although _____________________ are also used.

14. CDSS & EHR
EHRs, e-prescribing systems, computerized physician order entry, and medication reconciliation systems all are strengthened by some form of clinical decision support.
CDSS should be implemented to an EHR system in order to achieve Meaningful Use Stage 1.
CDSS has been a requirement measure to achieve Meaningful Use State 2 for the improvement of performance on high-priority health conditions.
The resource specification is available from here:
Stage 1:
Stage 2:

15. CMS Meaningful Use Regulations
An effort lead by CMS (Centers for Medicare & Medicaid Services)
CMS: Previously known as the Health Care Financing Administration (HCFA), is a federal agency within the United States Department of Health and Human Services (DHHS)

16. Meaningful Use: 13 Core Objectives
Computerized provider order entry (CPOE)
Drug-drug and drug-allergy checks
Maintain an up-to-date problem list of current and active diagnoses
E-Prescribing (eRx)
Maintain active medication list
Maintain active medication allergy list
Record demographics
Record and chart changes in vital signs
Record smoking status for patients 13 years or older
Implement clinical decision support
Provide patients with the ability to view, download, or transmit their health information online
Provide clinical summaries for patients for each office visit
Protect electronic health information

20. Clinical Practice Guidelines

21. Clinical Practice Guidelines (CPGs)
_________________________ to assist practitioners and patient decisions about health care for specific clinical circumstances
The very best evidence based medical information and formulate an approach to treat a specific disease or condition.
CPGs represent ______________ in which evidence is transformed into a recommendation at the point of care.
Many medical organizations use CPGs with the intent to improve quality of care, patient safety and or reduce costs.

22. CPG Example: Post-Traumatic Stress Disorder (PTSD) Evaluation

23. Barriers to CPGs Practice setting Contrary opinions ________________
________________, impractical or confusing
No uniform level of evidence rating system
____________________
Excessive influence by drug companies
Quality
_________________

24. Ambulance Tasmania - Clinical Practice Guidelines

25. Web-based CPGs
National Guideline Clearing House, offered by AHQA, U.S. DHHS
National Institute for Health and Clinical Excellence (NICE)
Agency for Health Care Research and Quality (AHRQ)
Institute for Clinical System Improvement (ICSI)

26. Setting Standards for Trustworthy CPGs
Establishing transparency;
Management of conflict of interest;
Guideline development group composition;
Clinical practice guideline–systematic review intersection;
Establishing evidence foundations for and rating strength of recommendations;
Articulation of recommendations;
External review; and
Updating.
By IOM, 2011