INTEGRATED CARE GUIDANCE

Clyde E. Wesp, Jr., MD, MAOMExecutive Clinical Strategist

Jacobus Consulting

OBJECTIVES

■Understand the importance of the relationship between EHR functionality and guiding evidence based care at the bedside

■Governance and processes of engaging clinicians in the evidence based content customization

■Advantages of built in evidence based care guidance with the EHR

TODAY’S AGENDA

■Why■Vocabulary■Care Guidance in action■The future of Healthcare Informatics■Questions

QUESTION # 1

■Has there been a time when you made a decision based upon incomplete information?

WHERE ARE WE GOING TO BEGIN?

WHY FOCUS ON CLINICAL DECISION SUPPORT?

■It makes a difference■Decrease unnecessary variation and waste■Method of Communication among clinicians■Integration of new evidence in context of current

literature■Helps clinicians make decisions■Focus on Outcomes■Regulatory

in·te·grate [ 'intəˌgreit ]“to make into whole”

■in·ter·face [ 'intəˌfeis ](in·ter·fac·es)• “A common boundary;to touch at a point to make things

join”

■em·bed [ em'bed ], [ em'bed ](, em·beds)• “to become deeply and solidly lodged in something

QUESTIONS TO ANSWER

■What is the difference between EBM, CDS and Care Guidance?

■What is the relationship between your EHR(s) and Care Guidance?

■Why integrate your EHR(s) and CDS?■How do you engage clinicians in the customization

of content?■What can you do to enhance Care Guidance?

QUESTIONS TO ANSWER

■What is the difference between EBM, CDS and Care Guidance?

■What is the relationship between your EHR(s) and Care Guidance?

■Why integrate your EHR(s) and CDS?■How do you engage clinicians in the customization

of content?■What can you do to enhance Care Guidance

WHAT IS EBM?

■The revised and improved definition of evidence-based medicine is “the integration of the best research evidence with clinical expertise and patient values”

■It reflects a systematic approach to clinical problem solving.

(Sackett DL, Strauss SE, Richardson WS, et al. Evidence-based medicine: how to practice and teach EBM. 2nd Ed. London: Churchill-Livingstone,2000)

WHAT IS EBM?

■The revised and improved definition of evidence-based medicine is “the integration of the best research evidence with clinical expertise and patient values”

■It reflects a systematic approach to clinical problem solving.

(Sackett DL, Strauss SE, Richardson WS, et al. Evidence-based medicine: how to practice and teach EBM. 2nd Ed. London: Churchill-Livingstone,2000)

PROCESS OF CARE

• Research• Science• Publications

• Application of EBM• Add Experience• Electronic Tools

• Content• Workflow• Alert Logic

CARE GUIDANCE

■Clinical Decision Support Applied■Embedded into workflow■Point of Care■Don’t have to leave the EHR■Instantaneous feedback■Anywhere, Anytime, Any Device

BARRIERS TO CARE GUIDANCE

■Reluctance to Use■Usability■Workflow■Right information at the right time to the right

person■Over-alerting leading to “alert fatigue”■Information overload

QUESTIONS TO ANSWER

■What is the difference between EBM, CDS and Care Guidance?

■What is the relationship between your EHR(s) and Care Guidance?

■Why integrate your EHR(s) and CDS?■How do you engage clinicians in the customization

of content?■What can you do to enhance Care Guidance

WHAT MAKES A CDS SYSTEM?

QUESTIONS TO ANSWER

■What is the difference between EBM, CDS and Care Guidance?

■What is the relationship between your EHR(s) and Care Guidance?

■Why integrate your EHR(s) and CDS?■How do you engage clinicians in the customization

of content?■What can you do to enhance Care Guidance

MEDITECH INTEGRATION FOR CLINICAL CONTENT

REDUCING DEPLOYMENT TIME, COST AND RESOURCES

MEDITECH INTEGRATION FOR CLINICAL CONTENT

INCORPORATING STANDARDIZED ORDER SETS, CARE PLANS, PHARMACY

QUESTIONS TO ANSWER

■What is the difference between EBM, CDS and Care Guidance?

■What is the relationship between your EHR(s) and Care Guidance?

■Why integrate your EHR(s) and CDS?■How do you engage clinicians in the customization

of content?■What can you do to enhance Care Guidance

NOT INTEGRATED INTO THE WORKFLOW

WHY IS IT IMPORTANT TO ENGAGE CLINICIANS?

■Clinicians play key role in the entire process■Knowledge experts■Nurses are responsible 24/7 in-hospital and through

community based services. They have great responsibility to recognize and prevent complications.

■Physicians are the clinical decision makers and through ordering practices drive cost and quality

■Physicians often practice independently. Engage them where they work.

■Nurse adoption influences physician adoption■Subject Matter Experts (e.g., Rx, Rad, Lab, Case Mgt)■Can be disruptive if not involved.

QUESTIONS TO ANSWER

■What is the difference between EBM, CDS and Care Guidance?

■What is the relationship between your EHR(s) and Care Guidance?

■Why integrate your EHR(s) and CDS?■How do you engage clinicians in the customization

of content?■What can you do to enhance Care Guidance?

QUESTION # 2

■Has there been a time in your organization that the right hand did not know what the left hand was doing?

CARE COORDINATION DEFINED?

CARE COORDINATION

Pharmacy

Medical Office

Home

Nursing Home

Hospital

Doctors Nurses

Care Managers

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REVIEW

Enhances the functionality of the EHRImmediate feedback to the clinician promoting safetyIntegrates documented data into decision making processSets up for mobile devices

“No one has the ability to capture and analyze data from the future. However,

there is a way topredict the future using data

from the past. It’s called predictive

analytics, and organizationsdo it every day.”

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PREDICTIVE ANALYTICSTHE NEXT STEP

7/8/15

CELEBRATE

■Acknowledge success■Acknowledge leadership■Acknowledge progress■Acknowledge more often than not■Thank people for their work■Award prizes for work■A few words go a long way■Balance work with fun■Celebration decreases stress