1. The Culture of Healthcare Healthcare Processes and Decision Making Lecture e This material (Comp2_Unit4e was developed by Oregon Health & Science University, funded by the Department of Health and Human Services, Office of the National Coordinator for Health Information Technology under Award Number IU24OC000015.

2. Healthcare Processes and Decision Making Learning Objectives 2 Describe the elements of the 'classic paradigm' of the clinical process (lecture a). List the types of information used by clinicians when they care for patients (lecture a). Describe the steps required to manage information during the patient- clinician interaction (lecture a,b,c). List the different information structures or formats used to organize clinical information (lecture b). Explain what is meant by the 'hypothetico-deductive' reasoning process (lecture a,b). Explain the difference between observations, findings, syndromes, and diseases (lecture a,b,c). Describe techniques or approaches used by clinicians to reach a diagnosis (lecture a,b,c,d,e). List the major types of factors that clinicians consider when devising a management plan for a patient's condition, in addition to the diagnosis and recommended treatment (lecture e). Health IT Workforce Curriculum Version 3.0/Spring 2012 The Culture of Healthcare Healthcare Processes and Decision Making Lecture e

3. Keeping Track Of Care “never ask a new patient a question without note- book and pencil in hand... Sir William Osler (1849 - 1919) 3 Health IT Workforce Curriculum Version 3.0/Spring 2012 The Culture of Healthcare Healthcare Processes and Decision Making Lecture e (Corner, 1905. PD-US)

4. Problem List Building Relationship, Negotiating Plans 4 Health IT Workforce Curriculum Version 3.0/Spring 2012 Diabetes –Polyuria, polydipsia, polyphagia –hyperglycemia HTN –high BP x 3 –EKG shows left ventricular hypertrophy Hyperlipidemia –LDL 194 –Triglycerides 250 Body Mass Index 34 The Culture of Healthcare Healthcare Processes and Decision Making Lecture e

5. Who is the Audience? What is the message for each? Patient Family, Friends, the Public Clinical staff – nurses, lab, x-ray, therapists, pharmacists, dietician Yourself – now and later Colleagues Consultants Insurance companies Lawyers (plaintiff and defendant) Compliance officers, regulators Researchers, data miners Performance measures 5 Health IT Workforce Curriculum Version 3.0/Spring 2012 The Culture of Healthcare Healthcare Processes and Decision Making Lecture e

6. Communicating with Patient Patient education – what’s wrong Instructions – what to do Reassurance – what will happen Motivation, hope Acknowledgement, acceptance “I’ll be there for you” 6 Health IT Workforce Curriculum Version 3.0/Spring 2012 The Culture of Healthcare Healthcare Processes and Decision Making Lecture e

7. Family, Friends, the Public What do they need to know? What will be best for the patient? What will be best for the family member? What can I legally tell? What can I ethically tell? 7 Health IT Workforce Curriculum Version 3.0/Spring 2012 The Culture of Healthcare Healthcare Processes and Decision Making Lecture e

8. Clinical Staff Nurses Pharmacist Dietician Therapists: physical, occupational, respiratory, massage, acupuncture Lab X-ray 8 Health IT Workforce Curriculum Version 3.0/Spring 2012 The Culture of Healthcare Healthcare Processes and Decision Making Lecture e

9. Oneself “Nothing clears up a case so much as stating it to another person” (Sherlock Holmes, 1893) Processing effect of recording case Effect of structure and order Impact of recording technology Prospective memory – notes to myself, a la “Memento” 9 Health IT Workforce Curriculum Version 3.0/Spring 2012 The Culture of Healthcare Healthcare Processes and Decision Making Lecture e

10. Other Clinicians Colleagues Future responsibility for patient Format Content Detail “Experts share knowledge not only of their domain, but of the structure and goals of their discourse” (Evans, 1989) Consultants Ask a clear question – get a much better answer What to share – what to leave out –Neurologist –Psychiatrist –Cardiologist –Radiologist 10 Health IT Workforce Curriculum Version 3.0/Spring 2012 The Culture of Healthcare Healthcare Processes and Decision Making Lecture e

11. Insurance companies Documentation of the illness –ICD9 Documentation of the procedure –CPT4 Documentation of the process –Details to support the diagnosis and treatment plan 11 Health IT Workforce Curriculum Version 3.0/Spring 2012 The Culture of Healthcare Healthcare Processes and Decision Making Lecture e

12. How much detail In what form? Lawyers Regulatory agencies Data mining Clinical and Outcomes research Quality and Performance improvement Patient Safety 12 Health IT Workforce Curriculum Version 3.0/Spring 2012 The Culture of Healthcare Healthcare Processes and Decision Making Lecture e

13. Healthcare Processes and Decision Making Summary – Lecture e This lecture examined: How clinicians gather patient data How they analyze it and utilize distinct techniques to reach a diagnosis and formulate a plan How clinicians communicate their plan with the patient and others who need information. 13 Health IT Workforce Curriculum Version 3.0/Spring 2012 The Culture of Healthcare Healthcare Processes and Decision Making Lecture e

14. Healthcare Processes and Decision Making Summary This unit examined the process of diagnosis and determination of a care plan: Role and nature of a clinician; classic and alternate paradigms Information gathering, process, analysis Diagnostic thinking and techniques Models used to choose therapy and formulate a management plan Communication of the management plan 14 Health IT Workforce Curriculum Version 3.0/Spring 2012 The Culture of Healthcare Healthcare Processes and Decision Making Lecture e

15. Healthcare Processes and Decision Making References – Lecture e 15 Health IT Workforce Curriculum Version 3.0/Spring 2012 References Conan Doyle A. Silver Blaze. The Memoirs of Sherlock Holmes (1893) Evans, D. A., & Gadd, C. S. (1989). Managing coherence and context in medical problem solving discourse. In D. A. Evans & V. L. Patel (Eds.), Cognitive science in medicine: Biomedical modeling (p. 214). Cambridge, MA: MIT Press. Feldman M, Christensen J. Behavioral Medicine: A Guide for Clinical Practice, Third Edition. McGraw-Hill Medical; 3 edition (2007) Ley P. Communicating with patients: Improving communication, satisfaction and compliance. Psychology and medicine series. New York, NY, US: Croom Helm. (1988) Images Slide 3: Corner, T. C. (1905). http://commons.wikimedia.org/wiki/File:Sir_William_Osler.jpg. Retrieved November 2011, from Wikimedia Commons website: http://commons.wikimedia.org. Public domain image (PD-US).http://commons.wikimedia.org/wiki/File:Sir_William_Osler.jpghttp://commons.wikimedia.org The Culture of Healthcare Healthcare Processes and Decision Making Lecture e