1. Component 11/Unit 7 Implementing Clinical Decision Support
Configuring the EHR
Component 11/Unit 7
Implementing Clinical Decision Support
This unit is part of component 11, Configuring the Electronic Health Record and discusses Implementing Clinical Decision Support. Clinical Decision Support broadly refers to providing clinicians or patients with computer-generated clinical knowledge and patient related information, intelligently filtered and presented at appropriate times, to enhance patient care. Clinical Decision Support systems provide information support to the clinician at the point-of-care and may be used pre-diagnosis, at the time of diagnosis, or post-diagnosis to improve the quality of care and promote patient safety.

2. Configuring the EHR for Decision Support
Alerts/notifications
Order Checks
Clinical Reminders
In this hands-on session, we will learn how to configure and use three tools for decision support implemented in the EHR: Alerts or Notifications, Order Checks and Clinical Reminders. These are standard functions that one would expect to find in any electronic health record.
Component 11/Unit 7
Health IT Workforce Curriculum Version 1.0/Fall 2010

3. Alerts/Notifications
Timely feedback on clinical events
May be informational or require action
Some may be mandatory (always on) while others can be enabled/disabled for user customization
Dynamic (Real time)
Alerts furnish providers with timely feedback regarding clinical events. Some alerts allow the user to perform a follow-up action while others are displayed for informational purposes. Normally, informational alerts will disappear after they are viewed. Alerts which require follow-up action, however, will not be removed until the required action is taken. Some alerts can be designated mandatory and cannot be disabled by the users while others can be turned on or off according to the users needs and preferences.
Ideally, clinical alerts are generated from a systematic, rule based, dynamic review of patient information from all modules of an EHR such as Laboratory, pharmacy, scheduling, etc.
Component 11/Unit 7
Health IT Workforce Curriculum Version 1.0/Fall 2010

4. Health IT Workforce Curriculum Version 1.0/Fall 2010
Order Checking
Rules based
Real time
Provides recommendations that the clinician usually has the option of overruling –i.e. does not replace clinician expertise.
Order checking is a component of the Order Entry process. It is based on a system of rules which reviews orders to see if they meet pre-defined criteria. If the order meets the criteria, an electronic message is transmitted to the provider before the order is completed. Examples of basic order checks would include duplicate order, duplicate drug class order, adverse reaction, and drug-lab interaction. Order Checks are real-time processes that occur during the placing of an order. Before orders are transmitted to the Laboratory, Pharmacy or other areas, orders are sent to Order Checking where the order is evaluated by an expert system against data from patient files and an order check message is displayed. The provider can choose to cancel the order or override the order check by entering a justification.
Component 11/Unit 7
Health IT Workforce Curriculum Version 1.0/Fall 2010

5. Health IT Workforce Curriculum Version 1.0/Fall 2010
Clinical Reminders
Especially useful for preventive health care and managing chronic diseases.
Provides timely reminders to aid in the tracking and documentation of care.
The Clinical Reminder functionality helps caregivers deliver quality patient care for both preventive health care and management of chronic diseases.
Clinical Reminders assist in the clinical decision-making process by allowing providers to view when specific tests or evaluations were performed and to track and document when care was delivered. The primary goal is to provide relevant information to providers at the Point of Care.
Component 11/Unit 7
Health IT Workforce Curriculum Version 1.0/Fall 2010

6. Health IT Workforce Curriculum Version 1.0/Fall 2010
Labs and Exercises
Hands-on look at Alerts/Notifications, Order Checks, and Reminders.
Provided by working through 3 corresponding labs and exercises.
To begin labs and exercises go to these files:
Comp11_unit7_lab1 & exercise 1
Comp11_unit7_lab2 & exercise 2
Comp11_unit7_lab3 & exercise 3
Now it is time to do the hands-on work with these functions by working through the corresponding labs and exercises. There is a lab and exercise for Alerts, Order Checks, and Clinical Reminders respectively. These labs and exercises are stand alone activities and can be completed in any order or worked through as indicated. It may be useful for the student to work through these activities more than once in order to develop the skills necessary to navigate and work with these functions of the EHR.
Component 11/Unit 7
Health IT Workforce Curriculum Version 1.0/Fall 2010