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The Classic Paradigm Classic paradigm assumes a single patient interacts with a single clinician Patient has a single problem Care is provided during a single episode Various tools mediate this process –Medical records –Computers –Clinical decision support 3 Health IT Workforce Curriculum Version 3.0/Spring 2012 The Culture of Healthcare Healthcare Processes and Decision Making Lecture a

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The Culture of Healthcare

Healthcare Processes and

Decision Making

Lecture a

This material (Comp2_Unit4a) 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

Welcome to The Culture of Healthcare: Healthcare Processes and Decision Making. This is Lecture (a).

The component, The Culture of Healthcare, addresses job expectations in healthcare settings. It discusses how care is organized within a practice setting, privacy laws, and professional and ethical issues encountered in the workplace.

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Healthcare Processes and Decision MakingLearning Objectives

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)

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Health IT Workforce Curriculum Version 3.0/Spring 2012

The Culture of Healthcare Healthcare Processes and Decision Making Lecture a

The Culture of Healthcare Healthcare Processes and Decision Making Lecture a

The objectives for Healthcare Processes and Decision Making are to:

Describe the elements of the 'classic paradigm' of the clinical process.List the types of information used by clinicians when they care for patientsDescribe the steps required to manage information during the patient-clinician interactionList the different information structures or formats used to organize clinical informationExplain what is meant by the 'hypothetico-deductive' reasoning processExplain the difference between observations, findings, syndromes, and diseasesDescribe techniques or approaches used by clinicians to reach a diagnosisList 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

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The Classic Paradigm

Classic paradigm assumes a single patient interacts with a single clinicianPatient has a single problemCare is provided during a single episodeVarious tools mediate this processMedical recordsComputersClinical decision support

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Health IT Workforce Curriculum Version 3.0/Spring 2012

The Culture of Healthcare Healthcare Processes and Decision Making Lecture a

The Culture of Healthcare Healthcare Processes and Decision Making Lecture a

This lecture is concerned with healthcare processes and decision making.

In this paradigm, the basic assumption is that a single patient is interacting with a single clinician about a single problem during a single episode of care. Various tools may be used to mediate the interaction, including medical records, computers, and clinical decision support; however, this discussion focuses on the one-patient, one-problem, one-clinician, one-episode of care scenario, in part because it is realistic in many situations and also because it helps to bound the problem.

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Classic ParadigmEvolution of tools that support the task

"Central Theorem of Health Informatics"human + computer > human aloneClassic Paradigm in Health Informaticsone patientone problemone clinicianone visitTechnology supports this 1:1:1:1 paradigm

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Health IT Workforce Curriculum Version 3.0/Spring 2012

The Culture of Healthcare Healthcare Processes and Decision Making Lecture a

The Culture of Healthcare Healthcare Processes and Decision Making Lecture a

This classic paradigm is somewhat analogous to what has been called the central theorem [theer-uhm] of health informatics [in-fer-mat-iks]. The central theorem was articulated by Chuck Friedman [freed-muhn], and his assumption in this theorem is that a human being working in the healthcare field will perform better when assisted by properly designed computer tools than when working alone. Most people working in biomedical informatics carry this assumption as the foundation of their work, even when it is unstated. Similarly, the classic paradigm is operative in many discussions, even when it is unstated. The paradigm is often assumed not only during the clinical process, such as making diagnostic or treatment decisions, but also during the interaction between clinicians and technology, for example the interaction between the physician and the electronic health record.

Because there is often a single patient with a single problem being addressed by a single clinician during a single visit, technologies have been developed that support this one-to-one-to-one-to-one arrangement.

This lecture also discusses other healthcare configurations in which computer tools need to be designed to serve other purposes, but for now, the focus is on this classic concept of the patient-clinician relationship.

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Attributes of Clinician

Possesses specialized knowledgeReceived experiential trainingHas direct relationship with patient and makes decisions about patient careActs in patients best interestIntegrates diverse types of informationFunctions within time & resource constraints

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Health IT Workforce Curriculum Version 3.0/Spring 2012

The Culture of Healthcare Healthcare Processes and Decision Making Lecture a

The Culture of Healthcare Healthcare Processes and Decision Making Lecture a

This unit frequently uses the word clinician [kli-nish-uh n] to refer to the individual who is providing care. It will be helpful to define this term more precisely. Here, the term clinician does not refer to a person who has any particular degree or educational background. After all, a person with a degree in nursing may be in a senior administrative position, such as the CEO. Most people would not call that work clinical. Similarly, a person with a doctorate in medicine may be developing computer systems or running a health insurance plan, and these forms of work are not clinical either. However, the work of patient care is performed by persons with a variety of educational and training backgrounds who may be considered clinicians. For the purposes of this lecture, the clinician is a person who possesses the following attributes.

First, a clinician is someone who possesses specialized knowledge, which is usually obtained through extensive education, such as medical or nursing school.

Second, a clinician is someone who has received extensive experiential training. For example, fields such as nursing and medicine require post-classroom learning, substantial training, and practice under supervision so that the clinician learns how to apply formal knowledge in practice.

Third, a clinician is a person who has a direct relationship with the patient. Regardless of ones training, indirect activities such as setting policy about patient care do not constitute clinical work, whereas direct interactions with the patient are considered clinical activities.

Fourth, a clinician is someone who combines his or her knowledge, training, and experience to make decisions about patient care, such as assessment or management of the patient.

Fifth, a clinician is a person who is expected to act in the best interest of the patient. This is referred to as a fiduciary responsibility, similar to that of a trustee for a trust, or a board member for an organization. Clinicians are expected to make choices and perform actions that are not in their own best interest, but instead are best for the patient.

Sixth, the clinician integrates diverse types of information, including not only individual knowledge of the patient and medical knowledge acquired in training, but also other information about local resources and constraints, as discussed later.

Seventh, clinicians are almost always functioning within significant time and resource constraints.

A clinician, then, is a person who possesses these attributes, whether it is a neurosurgeon, a clinical pharmacist, or a physical therapist.

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Types of information

4.1 Table: Types of information that clinici