1. Clinical Information Systems HINF 371 - Medical Methodologies Session 5

2. Objective To review types of information needed in decision making in a clinical setting To review types of information needed in decision making in a clinical setting

3. Reading Geisbuhler A and Miller RA (2000) Chapter 14: Computer Assisted Clinical Decision Support, in Decision Making In Health Care: Theory, Psychology and Applications, Cambridge University Press, USA Geisbuhler A and Miller RA (2000) Chapter 14: Computer Assisted Clinical Decision Support, in Decision Making In Health Care: Theory, Psychology and Applications, Cambridge University Press, USA

4. Decision Support Needs 52 percent patient specific information 52 percent patient specific information 23 percent general knowledge that could be found in a library, textbook, or Medline 23 percent general knowledge that could be found in a library, textbook, or Medline 26 percent synthesis of patient information and medical knowledge 26 percent synthesis of patient information and medical knowledge

5. Patient Information Computerized patient information Computerized patient information Better availability Better availability Better readability Better readability Clear and well organized displays of informatin Clear and well organized displays of informatin Ability display trends and patterns Ability display trends and patterns Ability to select and organize subsets of information Ability to select and organize subsets of information Physicians most interested in Physicians most interested in Which drugs Which drugs What happened in last hospitalization What happened in last hospitalization What are the lab results What are the lab results What is the status during the last visit to the physicians What is the status during the last visit to the physicians

6. Difficulties with Computerized Patient Information Getting data into the system – physicians are not good at it Getting data into the system – physicians are not good at it Transcription and interpretations of patients records Transcription and interpretations of patients records Voice recognition Voice recognition Provision of immediate feedback as data entered Provision of immediate feedback as data entered Getting information out of the system Getting information out of the system Difficulties in implementation Difficulties in implementation Busy care providers are reluctant to use systems that slow their work Busy care providers are reluctant to use systems that slow their work 25percent of difficulties are technology related 25percent of difficulties are technology related 75 percent of difficulties are caused by inadequate social engineering/change management 75 percent of difficulties are caused by inadequate social engineering/change management

7. General Knowledge Ability to perform literature searches using Medline Ability to perform literature searches using Medline Improved decisions Improved decisions Reduce costs and length of stay Reduce costs and length of stay Other sources of information Other sources of information Textbooks Textbooks Full-text journals Full-text journals Practice guidelines Practice guidelines Printable educational material for patients Printable educational material for patients Drug information database Drug information database

8. General Knowledge Local policy and procedures Local policy and procedures Formalized policy and procedures Formalized policy and procedures Operational rules Operational rules Functioning of institution Functioning of institution How to apply and break rules How to apply and break rules Resource inventories, operating hours, names of people, turn around times for lab tests, etc. Resource inventories, operating hours, names of people, turn around times for lab tests, etc.

9. General Knowledge Many medical errors are results of intrinsic limits in physician’s ability to process ongoing events Many medical errors are results of intrinsic limits in physician’s ability to process ongoing events Attention focusing tools Attention focusing tools Drug interactions (can be done through EMR or Order Entry) Drug interactions (can be done through EMR or Order Entry) Reminders for tests, follow-ups, information transfer, etc. Reminders for tests, follow-ups, information transfer, etc. Results of past tests Results of past tests Ranges of normal and likelihood of normal for given tests Ranges of normal and likelihood of normal for given tests

10. Patient Specific Support Diagnostic decision support systems Diagnostic decision support systems Clinical algorithms – BC Nurseline or Healthwise http://bchealthguide.org/kbaltindex.asp Clinical algorithms – BC Nurseline or Healthwise http://bchealthguide.org/kbaltindex.asp http://bchealthguide.org/kbaltindex.asp Predictive Tools http://groups.csail.mit.edu/medg/project s/hdp/hdp-intro-tab.html Predictive Tools http://groups.csail.mit.edu/medg/project s/hdp/hdp-intro-tab.html http://groups.csail.mit.edu/medg/project s/hdp/hdp-intro-tab.html http://groups.csail.mit.edu/medg/project s/hdp/hdp-intro-tab.html

11. Patient Specific Support Clinical Algorithms Clinical Algorithms Problems of scalability Problems of scalability Inability to deal with uncertainty or incorrectness inherent in the nature of clinical data Inability to deal with uncertainty or incorrectness inherent in the nature of clinical data Better used in non-intersecting subsets Better used in non-intersecting subsets Predictive tools Predictive tools How representative are the patients who were used in developing a given predictive tool How representative are the patients who were used in developing a given predictive tool Which patients are likely to be misclassified and subjected to unnecessary interventions Which patients are likely to be misclassified and subjected to unnecessary interventions How severe are the adverse effects that occur in patients receiving unnecessary interventions How severe are the adverse effects that occur in patients receiving unnecessary interventions How integrated the system to the workflow of physicians within the architecture of clinical information systems How integrated the system to the workflow of physicians within the architecture of clinical information systems

12. The clinical significance of a computer based decision support tool resides in the ability to augment the native skills of the physician during clinical practice, not its function in isolation as an “omniscient oracle” Miller 1996 The clinical significance of a computer based decision support tool resides in the ability to augment the native skills of the physician during clinical practice, not its function in isolation as an “omniscient oracle” Miller 1996

13. Is Medicine a science or an art? Discussion