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Module 3: chapter 10, 19, 20, 21, and 24
Terms in this set (77)
Why are clinical decision support systems (CDSS) important (ch10)?
By providing the right information to the right person at the right time
CDSS can support effective clinical decision making and improve clinical care.
Goal of health IT: A safer healthcare (ch10):
One of the central goals of health IT has always been to:
1. help clinicians in the decision-making process to prevent errors
2. maximize efficiency
3. enable evidence-based care
4. ultimately improve health and healthcare.
Healthcare errors can be prevented- especially using process improvement measures enabled by technology and CDS tools
What is clinical decision support (ch10)?
A variety of tools and interventions that provide clinicians with knowledge and person-specific information presented at an appropriate time to enhance health care.
Guides nursing care by providing key information at key times
Patient care decision-making (ch10):
1. Reminders about specific care needs (e.g. patient do an immunization)
2. Alerts about specific care actions that may impose a risk to the patient (e.g. medication interactions)
3. Providing helpful views of a patient's record that help better understand the status of the patient (e.g. patient dashboards)
4. Tools that assist in implementing and documenting decisions more efficiently and accurately (e.g. order sets, medication reconciliation tools)
5. Clinician access to patient-specific reference information available in online knowledge resources (e.g. links to external sites)
6. Access to information about similar patients in the population along with their treatments and outcomes
7. Advanced analytics to estimate risks for a specific individual, such as risk for hospital readmissions, cardiovascular events, and risk for falls
Examples of clinical decision support (ch10):
1. Medication dosing support:
- Tools that assist clinician in finding and monitoring the most appropriate doses for medication orders.
2. Order Facilitators
- Tools that assist clinicians in the order entry process in general.
3. Point-of-care alerts & reminders
- Raise the clinician's attention to important conditions or recommendations based on the patient's clinical data
- *Caution: overuse may lead to alert fatigue
Relevant Information Display (ch10):
Addresses clinicians' information overload related to patient information and domain knowledgeProvides seamless access to relevant patient information or summarize prominent aspects of a patient's record to help clinicians understand the patient's condition and status.
Expert systems (ch10):
Provide diagnostic or therapeutic advice based on patient parameters
Contain more sophisticated computer logic- less frequently found in commercial EHR systems
Goes beyond decision support and automates the decision-making process
Workflow support (ch10):
Tools that aid in important step of the patient care workflow:
1. Care transitions
2. Patient documentation
Ex. Medication error prevention using medication reconciliation tools during care transition
Effectiveness of clinical decision support (ch10):
1. Improved practitioner performance
2. Improved patient outcomes
Financial impact of CDS (ch10):
To the extent that CDS can facilitate desired changes in clinical practice patterns and patient outcomes, CDS can lead to positive returns on investment
Financial benefits may be to stakeholders rather than to those investing in the CDS
Challenges/barriers to CDS adoption (ch10):
1. Lack of incentives
- Healthcare payment model fails to reward the provision of higher-quality care
2. Implementation challenges
- Must have strong organizational culture and design implementation plan
3. Low EHR adoption
- Changing rapidly with meaningful use
4. Multiple data sources with little information exchange
- Data sources not shared with the EHR providing CDS
Clinical decision support: best practices (ch10):
- Best practices help maximize the likelihood that CDS initiatives will lead to the desired outcomes
- 5 Rights:
Provides the right information to the right person using the right CDS intervention format, delivered through the right channel at the right point in workflow
CDS standards (ch10):
1. Sharing structured CDS knowledge resources (e.g., order sets, alert definitions)
2. Sharing CDS capabilities over a secure internet connection (e.g., sending anonymous patient data to a secure web server, with returns evidence-based care recommendations)
*A critical element is that common standards are used with the various interacting health information systems so that the approach can scale widely and be implemented at a relatively low cost.
The decision to implement a new health IT system or upgrade and existing one is based on several factors (ch19):
1. Providing safe and up-to-date patient care
2. Meeting federal mandates (Meaningful Use or Medicare Access)
3. Leveraging advanced levels of clinical decision support
Changing government regulation (ch19):
1. American Recovery and Reinvestment Act (ARRA)
- HITECH Act
- Certified digital medical records by 2014
- Electronic exchange of health information across healthcare institutions
2. Meaningful Use (MU)
- INCENTIVE program to encourage adoption of EHR- does not cover total costs
- Use EHR in a meaningful way
- Foster faster adoption rates of EHR
CMS criteria (ch19):
- CMS established criteria for Meaningful Use
- Minimal thresholds for select objectives
- 3 stages of the EHR Incentive Program
-EHR must be "certified"- certified by the Office of the National Coordinator for Health Information Technology (ONC):
1. System must have functionality, required data elements, and logic to support ambulatory, emergency room, outpatient, and inpatient MU requirements
2. Meaningful Use criteria does not require that facilities purchase a commercial, certified product- some hospitals and eligible providers have developed their own "homegrown" EHRs
1. Evidence-based content:
- The use of current best evidence in making decisions about the care of patients
- Integrating individual clinical expertise with the best available external clinical evidence from research (e.g. order sets that are standardized, but can be customized based on the needs of the patient)
2. Clinical decision support systems:
- 5 "rights"- right information to right person in right format through rightchannel at right time.
Advantages of EB content and CDS (ch19):
1. Defines standardized, appropriate care and reduces variability of care for common diagnoses
2. Defines local or facility-owned orderables (elements that can be ordered using CPOE available at that facility)
3. Triggers alerts based on locally built logic
4. Collects detailed metrics for specific reports required to meet MU requirements (e.g. smoking status assessment, patient education, dvt prophylaxis protocol)
5. Enables more timely update of treatment plans based on best practices
Patient safety and improved quality of care (ch19):
What is the primary reason for MU?
- The primary reason for MU is to promote patient safety- not meet MU requirements (although healthcare professionals may think so)
Patient safety and improved quality of care (ch19):
What are the major implementations and/or upgrades can result in pushback from healthcare providers?
1. Often involves changes to workflow and processes which can result in temporary decrease in productivity (especially in early stages)
2. Some individuals may focus on the negative aspects such as time intensive effort to enter orders rather than positive outcomes and safer patient care
Unintended Consequences: Associated with human error (ch19)
What are the types of errors?
1. Juxtaposition error - selecting wrong patient, medication, etc from a list
2. e-iatrogenesis- a type of error associated with users who fail to validate or read the list of all orders entered during a session before final acceptance or who accept the defaults for select orders without review
Unintended Consequences: Associated with human error (ch19)
What are the Intervention to minimize riska:
1. Tall man lettering- use of mixed case lettering for "look alike-sound alike" medications to decrease med errors by highlighting the differences in the names
(e.g. DOBUTamine vs. DOPamine)
2. CMS approved abbreviations
3. Real time updates
New implementation vs System upgrade (ch19):
- Questions that must be asked:
"Do we need to make a change?"
"What specific changes are needed"
- Must meet goals- including MU criteria
- If using a well-established homegrown system, an upgrade may be best
Sufficient resources (ch19)
What are the 3 major resources necessary?
1. Staff- Do we have enough staff? and Do they have the necessary skills?
2. Budget- projects are expensive-- $ needed for staff, servers, hardware, software, and post-live vendor support. Often have unexpected costs (adding memory, upgrading wireless systems, & developing new interfaces)
3. Physical or environmental constraints- may need to add additional space in clinical units, patient rooms, dictation areas, doctor lounges, etc.
Risk factors (ch19):
1. Identify all probable and possible risk factors that may interfere with achieving a successful project- completed on time, with sufficient quality, and within budget
2. Expected and unexpected
Opportunities for improvement (ch19):
- Increase patient safety and quality of care
- Enhance communication
- Increase evidence-based practice (EBP)
- Create more efficient workflows and processes
- Introduction of more advanced clinical decision support—logic- specifically rule-based logic (Alerts are triggered when orders contradict patient data)
Implementation and the Systems Life Cycle (ch19):
3. Develop or purchase.
5. Implement or go-live.
6. Maintain and evolve.
Project planning (ch19):
What is success?
1. Must be measureable terms or goals
2. Adhere to project plan with management principle
- Staff (IT & Nursing), representatives from each department, superusers
Project planning (ch19):
1. Executive management support
- Support & positivity from kick-off to Go-Live and enforce policy
2. Engaging stakeholders
- Solicit input from representatives from all disciplines
3. Redesigned workflow
- Preparation so that processes match the EHR functions
- Prevent negative workarounds
Building/tailoring the product (ch19):
1. Build or tailor EHR to match new workflow
2. Involve end-users in process
3. End-users evaluate module using iterative fashion
- Keep number of "clicks"/amount of scrolling to a minimum
- Do not ask clinicians to respond to prompts that they cannot answer
- Maintain a consistent look and feel to the screens so that the same information is always found in the same place on the screen and color coding is consistent
1. Testing must be extensive when implementing or upgrading a system
2. Testing of: hardware, software, and functional testing
3. Functional testing- used to determine whether the system functions as designed and works effectively and with the newly structured work processes
4. All testing should be done FIRST within a module- after functional, testing in modules should be done using patient flow scenarios
5. Test plan- the testing process
Go-Live Prep (ch19):
1. Big bang - when all applications or modules are implemented at once
- Less expensive & implementation time is shorter
- Significant reductions in productivity immediately and for a short time afterwards due to user unfamiliarity with new system
2. Phased go-live- both paper and electronic environments exist at the same time within the healthcare institution
- Usually done when facility has limited resources and cannot support a house-wide implementation or low tolerance to change
Go-Live plan (ch19):
- Detailed plan that includes each planned activity assigned to a specific individual/team with a completion date for each task
- May include:
1. Cross-checking patient info between new and old systems
2. Backloading a specific number of days of diagnostic test results and medications into new EHR
3. Confirming that all active and future orders on all patients are in the new EHR
Education and training (ch19):
- Insufficient time to thoroughly train end users/failure to allot sufficient budget to conduct training are common mistakes
- Training of end users should be a project in itself and should be conducted by persons in education department that can coordinate/oversee all of its components
- In-house staff, vendor educators, consultants, super users, or a mix
- In-house educators have knowledge of facility policies and procedures and have background in adult education
- Vendor educators and consultants know the product very well, but are unfamiliar with workflow and policies
- Super users are valuable in classroom and in practice
What are the training methods (ch19):
1. Instructor-led in classroom
2. Blended online module and instructor-led session
3. No matter which approach, the use of competency tests to assess proficiency is recommended
4. Physicians may need CPOE liaisons during work day
- Close support is needed in the first few weeks of implementation for end users
- Assign super users
Tips for success:
1. Go-Live date that is convenient
2. Organized, well-equipped command center
3. Highly publicized hotline for user help
4. System for reporting identified issues
5. Vendor representative or IT support for urgent support issues
Post-live maintenance (ch19):
- After vendor support ends, in-house support should continue
- Maintain system with day-to-day changes that take place
- IT support personnel should make regularly scheduled rounds to units
- Evaluate the outcome of the system to see if it improved workflow and patient outcomes
Large or small, healthcare facilities are dependent on (ch20)?
Computerization to provide quality healthcare.
Facilities and providers must be prepared for (ch20):
- Given the importance of health IT, facilities and providers must be prepared for any kind of downtime (i.e. human error, software/hardware failure, severed power cables, software viruses, natural occurrences/disasters).
- Downtime is expensive! Average cost of downtime is approx. $8000/min- not to mention the risk to patient care...
- Therefore, we need a plan...
Downtime Risk Assessment (ch20):
1. Planning for downtime can and should occur from project inception through system support, and maintenance and must include all existing systems and infrastructure.
2. Downtimes can be classified by the root cause and the degree of impact
3. Determining the root cause of a downtime is not always straightforward
- first step is to determine what is and what is not functioning
Preventing/managing downtime (ch20):
1. Determine what might cause a downtime and then to perform a risk assessment of the impact for each potential downtime.
2. Identify the most common potential causes of a downtime in the facility, areas of vulnerability, and the most likely scenarios of natural disasters or human-made disasters in the geographic area.
3. Complete an inventory of all systems and document them. All systems in use at the organization should be inventoried, because each is important to some aspect of the business.
4. An inventory list can be difficult to compile- may need to do unit walk-throughs to observe systems and devices that are in use
5. Work with emergency preparedness officers within the facility to prepare for disasters
Type of System (ch20):
1. Core clinical applications
- ex. Electronic medical record (EMR), electronic health record (EHR), emergency department, computerized provider order entry (CPOE), clinical documentation, medication administration record (MAR), surgical services, and anesthesia information system
2. Ancillary service and procedure area information services
- ex. Pharmacy, radiology and imaging, laboratory, arterial blood gas, cardiology, endoscopy, respiratory, neurology, nutrition care, dictation, health information management, biomedical devices (physiologic monitors, vital sign machines, intravenous pumps, ventilators, pneumatic tube systems, etc.)
3. Online reference databases
- ex. Drug information references; patient education; policies and procedures; disease, diagnosis, and interventional protocol databases; formulas or health-related calculators
4. Revenue cycle
- ex. Admission, discharge, and transfer; enterprise scheduling; preauthorization; facility and technical billing; health information (HIM), document management (scanning), coding; professional and physician billing; claim scrubbers; print vendors; address verification; electronic data interchange (EDI) transactions; benefit checking
5. Business, finance, and personnel
- ex. E-mail, office software, cash collections, credit card transactions, banking, business intelligence, reports and reporting, supply chain and enterprise resource planning (ERP), budgeting, human resources, payroll, staff scheduling, keyless entry, facilities and engineering, telephone systems and wiring, telephone operators, paging systems, wireless communication devices
- ex. Printers, Bluetooth devices (scanners, label printers), reports, data warehouse, barcode scanning, print vendor, internet-based public web pages, intranet and related internal web sites, wikis, clinical health information exchanges, retail outlets (retail pharmacies, gift shops, food service)
Downtime and Response Planning (ch20):
- Define types of potential downtimes•On continuum based on the degree of significance for each type of downtime
- The significance of the different downtimes will depend on the level of complexity and the installed base of the institution
- Consider both planned and unplanned downtimes.
- If a downtime is scheduled, there should be ample time to plan
- If the downtime is unexpected, no contingency plans may be in place
- A worst-case scenario should be planned for
- Once the organization has clear definitions for downtimes and has methods of assessing the significance of potential events, the emergency preparedness and disaster planning team can develop the response, communication, and recovery plans
- A comprehensive and accurate assessment will provide a reliable starting point for the team responding to the downtime-- decreasing chaos and saving critical time at the start of an event.
- The downtime plan will include different levels of interventions for various events.
- Downtime response planning is key to disaster recovery
Clinical impact and planning: Acute care focus (ch20):
- With the increased use of technology at the point of care and in the clinical environment, healthcare organizations must now precisely determine their response when technology is unavailable.
- How do clinicians find historical data, including recent vital signs, the first of three troponin results, the history and physical prior to surgery, and the last time the PRN (as needed) pain medication was given, with the patient's response to it? How do healthcare providers document new events, medications, orders, and treatments? How does the pharmacy dispense a medication and keep track it? How do ancillary systems such as radiology and pharmacy receive handwritten orders?
Redundant Systems (ch20):
- AKA- "Back up system"
1. provide clinicians the ability to access some if not all patient data during an electronic downtime
2. If clinicians can recover just enough information to carry on with patient care from the point at which the downtime begins, care can proceed safely
3. Each individual organization should define the required subset of data according to applications and services. (e.g. basic demographics, orders, medication administration records (MARs), most recent vitals, laboratory values, imaging reports, and physician and provider progress notes)
Limitations of redundant systems (ch20):
1. Downtime machines are no longer updated with patient information
- This requires the healthcare providers to check the new manually recorded data as well as the historical data maintained in the temporary system when providing care
2. Data may be organized differently than in the EHR
- Information may be displayed or printed in a different format- may cause confusion and even errors in patient care
3. Data entry for the downtime may not be complete- resulting in a fragmented or incomplete record.
4. Downtime solution using temporary machines must meet Health Insurance Portability and Accountability Act (HIPAA) requirements for security, privacy, and confidentiality.
Downtime Policies and Procedures (ch20):
- Approved downtime policies and procedures are needed to guide the clinical team.
- These policies should be prescriptive, include roles and responsibilities, and define workarounds or manual procedures that allow for the continuity of critical functions.
- They should include specific instructions about required data entry to the legal and permanent EHR record at the conclusion of the downtime.
Disaster Planning (ch20):
- Organizations are obligated to maintain contingency and disaster plans in order to be compliant with the HIPAA security rule of 1996, the U.S. Department of Health and Human Services, and accreditation bodies.
- A separate set of IT policies should exist to supplement the organization's overall disaster plan and include security and privacy components.
- Senior leadership of the IT department, the security and privacy office, the emergency preparedness group, and senior leadership from the broader organization should review and approve the plans.
- These plans should be frequently reviewed, tested, and revised as needed. Staff need to be updated on a consistent basis so they are prepared to implement contingency and disasters plan with minimum
Disaster Recovery (ch20):
- The goal of disaster recovery is to recover the business fully and completely
- Depending on the severity of the event or disaster, it may be necessary to do an incremental recovery.
- Key administrative leaders, with input from the staff, should be involved in the decisions about the sequence of recovery of systems or applications.
- All employees in an organization will likely have changed workflows during the disaster, and it is important that they understand their roles during the disaster or downtime and during the recovery period.
- The steps to actual recovery will be different for each event and for each organization.
- Communication is an integral part of any downtime. Five components of communication plans are needed to determine the following:
1. Who needs to know the details?
2. What details are needed?
3. What media or modes of communication will be used?
4. Who will communicate what information?
5. What systems or workflow processes are affected?
1. The IT staff is responsible for communicating the necessary information to the help desk agents
2. Some electronic systems contain notification alert capability.
- this method would not be available during an EHR downtime, but it can be used to announce a planned downtime or when any of the ancillary systems are offline.
3. IT leaders are responsible for communicating with the organization's senior leadership and the public relations department so they can manage media relations with the community.
4. Social media applications can be used to manage information with the media and to distribute information to staff in the event of a downtime (assuming that staff members have subscribed to the service and the service can provide the appropriate level of security and privacy).
Current User Experiences (ch21):
- Evidence exists that UX issues can result in patient safety problems and errors.
- Physicians are most vocal about dissatisfaction and productivity issues with EHRs.
- Nurses are particularly affected by excessive documentation requirements.
- Nurses indicate that EHRs are a hindrance to care because they take time away from patients.
**Improved usability and user experience could have prevented these issues.
Define User experience (ch21):
"a person's perceptions and responses that result from the use or anticipated use of a product, system, or service" (ISO 9241-11).
How the user feels about it.
Define Human factors (ch21):
"the scientific discipline concerned with the understanding of interactions among humans and other elements of a system, and the profession that applies theory, principles, data, and methods to design in order to optimize human well-being and overall system performance."
Understanding how people interact with things.
Define Ergonomics (ch21):
Its focus is on human performance with physical characteristics of tools, systems, and machines. Deals with comfort and safety for the user.
Define Human-Computer Interaction (HCI) (ch21):
Is the study of how people design, implement, and evaluate interactive computer systems in the context of users' tasks and work.
Define Usability (ch21):
- Is the extent to which a product can be used by specific users in a specific context to achieve specific goals with effectiveness, efficiency, and satisfaction
- Is often used interchangeably with HCI when the product is a computer; however, usability also concerns products beyond computers.
User-Centered Design (ch21):
User experience experts insist on the process of user-centered design that is made up of three axioms:
1. An early and central focus on users in the design and development of products
2. Iterative design - repetition in design and evaluation
3. Systematic measures of the interactions between users and products
Task Analysis (ch21):
- Systematic methods used to understand what users are doing or required to do with a health IT product.
- Focuses on tasks and behavioral actions of the users interacting with products
- Provide a process for learning about and documenting how ordinary users complete actions
- Helps to identify task completeness, correct/incorrect sequencing of tasks, accuracy of actions
- Obtained through interviews, observations, shadowing users at their actual work sites
Formal User Testing (ch21):
- May be done at any time in the systems life cycle.
- Researchers recommend at least 15 users for testing.
- Consists of usability questionnaires
1. **System Usability Scale Brooke, 1986
2. Questionnaire for User Interaction SatisfactionNorman and colleagues, 1998
3. Purdue Usability Questionnaire Lin and colleagues, 1997
4. Software Usability Measurement Inventory Kirakowski, 1993
Determining User Needs and Requirements (ch21):
- Requirements are determined early in the product development life cycle.
- Requirements concentrate on:
1. Users' characteristics
3. Work design
5. Requirements about environments
Define Quality of care (ch24):
"the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge."- IOM
What does quality of care look like (ch24):
1. Safe = Prevents injury or other adverse outcomes
2. Effective = Ensures that evidence-based interventions are used, with patients always receiving the treatments most likely to be beneficial
3. Patient-centered = Ensures that patient preferences, needs, and values are front and center in the process of clinical decision making
4. Timely = Delivered when needed and without harmful delays
5. Efficient = Prevents the waste of valuable human and material resources
6. Equitable = Provided to all individuals without regard for ethnic, racial, socioeconomic, or other personal characteristics
Define patient safety (ch24):
"freedom from accidental injury due to medical care, or medical errors," where erroris defined as "the failure of a planned action to be completed as intended or the use of a wrong plan to achieve an aim."- IOM
Safety: "the reduction of risk and unnecessary harm to an acceptable minimum" and patient safety as "the reduction of risk of unnecessary harm associated with healthcare to an acceptable minimum."- ICPS
The ICPS defines error as "failure to carry out a planned action as intended or application of an incorrect plan" and healthcare-associated harm as "harm arising from or associated with plans or actions taken during the provision of healthcare, rather than an underlying disease or injury."
What we learned from the IOM reports on quality (ch24):
- The U.S. needs a systematic redesign of established clinical processes
- Health IT is needed to support and maintain the transition to best practices
- Recent U.S. policy is aligning incentives with the goal of adoption and widespread use of health IT to ensure quality and safety
- Federal Health Information Technology Strategic Plan: 2011-2015:
1. The ONC's plan for working with public and private sectors to achieve the nation's health IT goals
2. ONC released Federal Health Information Technology Strategic Plan: 2015-2020- to highlight achievements of Meaningful Use and where IT infrastructure is lacking (e.g., interoperability & patient-centeredness)
Federal health information technology strategic plan 2015-2020 (ch24):
- Two objectives:
1. To use health IT to make care safer
2. To improve the safety of health IT
- Key areas of focus :
1. Improving the quality of care
2. Preventing adverse events
3. Adverse events: an undesirable experience associated with the use of a medical product in a patient.
Quality data standards (ch24):
- Establishing and adopting standards at multiple levels to support semantic interoperability
- Semantic interoperability: data are exchanged without a loss of context or meaning and therefore can be reused without special effort on the part of the user
- Only possible when all organizations adopt the same standards for quality measurement and reporting and using those standards in their electronic systems
The ultimate goal (ch24):
1. Capture data for quality reporting in the context of existing documentation workflows
- This requires that standard clinical content is adopted and used in electronic systems, standard vocabulary is used to encode that content and messaging standards are used to transfer information from one healthcare organization to another
2. Standard quality measures are needed to ensure that all organizations are using consistent metrics for benchmarking
3. Organizations are using the same types of data to populate the quality metrics
Evaluating quality and patient safety (ch24):
1. Buildings, equipment, staffing ratios, budget
2. All factors may not be under the control of the local facility (e.g., Joint Commission standards or MU requirements)
1. Clinical and managerial processes that support the provision of care
1. The end result of the structures and processes in place (clinical outcomes and throughput)
PSQRD framework (ch24):
- Supports understanding where the health IT intervention is most likely to have an effect
- Pertinent for evaluating the effect of health IT interventions on quality and patient safety- provides a means to explain why a health IT interventions was successful (or not)
Medication safety (ch24):
- Health IT is proven to improve the quality and safety of care in relation to medication safety
- CPOE and CDS systems implemented in clinical practice have reduced errors in the process of ordering medications
- Bar Code Medication Administration and eMAR systems have been implemented to streamline clinical workflow, focusing on improving medication administration at the point of care.
1. Ensure that providers adhere to the "5 Rights" of medication administration WHEN used properly- NO WORKAROUNDS!!
- Smart infusion pumps
1. Med error reduction by having pre-programmed drug libraries with dose limit alerts
- IOM reports, TJC standards and National Patient Safety Goals (NPSG) represent structural incentives for use of health IT to improve medication safety
What determines improvement (ch24):
Evidence shows that successful implementation of BCMA and eMAR systems that improve patient safety depend on:
1. Workplace culture (leadership, teamwork, and clinician ownership)
2. Training and support
3. Acceptance of the major impact of work practices by all staff
4. A usable system with adequate decision support
Chronic illness screening and management (ch24):
Using health IT to improve clinical processes includes:
1. Clinical decision support based on clinical practice guidelines
2. Pay-for-performance measures
3. CMS core measures
Improving quality outcomes (ch24):
Use health IT interventions that target patients to improve :
1. Access to treatment
2. Adherence with medication, diet & exercise regimens
3. Adherence to recommended screening guidelines
4. Engagement in symptom management
Patient falls and pressure ulcers: specifically for nurses (ch24):
- Falls and pressure ulcers are preventable and are sensitive to nursing care
- Using health IT to prevent these occurrences are key to quality nursing care and positive patient outcomes
- CDS critical to falls and pressure ulcers
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