The Culture of Healthcare Healthcare Processes and Decision Making Lecture a This material...

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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

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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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Page 1: The Culture of Healthcare Healthcare Processes and Decision Making Lecture a This material (Comp2_Unit4a)…

The Culture of HealthcareHealthcare Processes and

Decision Making

Lecture aThis 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

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Healthcare Processes and Decision Making

Learning 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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The Culture of Healthcare Healthcare Processes and Decision Making

Lecture a

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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

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The Culture of Healthcare Healthcare Processes and Decision Making

Lecture a

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Classic ParadigmEvolution of tools that support the task

• "Central Theorem of Health Informatics"– human + computer > human alone

• Classic Paradigm in Health Informatics– one patient– one problem– one clinician– one visit

• Technology supports this 1:1:1:1 paradigm

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Attributes of Clinician• Possesses specialized knowledge• Received experiential training• Has direct relationship with patient and makes

decisions about patient care• Acts in patient’s best interest• Integrates diverse types of information• Functions within time & resource constraints

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Types of information

Patient Data refers to one person patient, family, records, observation

Population Statistics aggregated patient data

colleagues, public health dept, EHR

Medical Knowledge generalizable to many persons

textbooks, journal articles, MEDLINE

Logistic Information how to get things done

people, policy and procedure

Social Influence how others get the job done

observe and discuss with colleagues

4.1 Table: Types of information that clinicians utilize when making decisions

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OrganizationHow clinicians organize information?

• Narrative structure• Rearranged into a history and physical format• Further rearranged into a hierarchy• Reformulated into a computable structure for

utilization by clinical information systems

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“Disease hides its secrets in a casual parenthesis”

(Tumulty, Philip A., nd.)

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How stories fit into health systemPart 1

• Communication between patient and clinician– Facts embedded in story (meaning to

clinician)– Meaning of the illness to the patient– Communication and relationship building– Therapeutic value– Important aspect of quality of care

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How stories fit into health systemPart 2

• Among Clinicians– Efficient communication among experts– Values and ethics are communicated through

stories• How do modern healthcare systems (and HIT)

affect stories?– Eliminate or alter them– Lose context

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InterpretationHow clinicians understand clinical data

• Disciplinary differences• Different approaches to clinical data

interpretation• Development of social construction• Contextual interpretation of data

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Beyond the Classic ParadigmCollaboration in Surgery

• Multiple disciplines with different roles and tasks• Short time horizon• Requires advance planning, resource rich

4.2 Table: Comparison of the classic paradigm with the operating room.

Patients problems clinicians visits

classic paradigm 1 1 1 1

operating room 1 1 many 1

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Beyond the Classic ParadigmUncertain, complex, high stakes

• Complex acute illness - multiple disciplines, roles, tasks

• Short time horizon, unplanned events, uncertain data

4.3 Table: Comparison of the classic paradigm with the operating room and acute complex illness.

The Culture of Healthcare Healthcare Processes and Decision Making

Lecture a

patients problems clinicians visits

classic paradigm 1 1 1 1

operating room 1 1 many 1

acute complex illness 1 many many 1 or more

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Beyond the Classic ParadigmUncertain, complex, high stakes

• Simultaneous care of multiple acute and non-acute - very short time horizon

• Planning for the unexpected, resources are often constrained• Coordination, cooperation, collaboration

4.4 Table: Comparison of the classic paradigm with the operating room, acute complex illness and emergency dept.

The Culture of Healthcare Healthcare Processes and Decision Making

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patients problems clinicians visitsclassic paradigm 1 1 1 1

operating room 1 1 many 1acute complex illness 1 many many 1 or more

Emergency dept many many many 1

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Steps in the Classic Process

• What is the matter?– diagnosis

• What can be done?– treatment

• What will happen?– prognosis

• Gathering data• Analyzing findings• Making a diagnosis• Choosing treatment• Communicating the

plan

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Healthcare Process and Decision MakingSummary – Lecture a

• Looked at types of information that clinicians use in the course of managing patients

• Defined the role and nature of a clinician• Examined the classic paradigm of the clinical

process and also looked at some alternate paradigms

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Lecture a

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Healthcare Processes and Decision Making

References – Lecture aReferences

• Evans, DA and Patel, V. (1989) Cognitive Science in Medicine: Biomedical modeling. MIT Press, Cambridge, MA Retrieved from http://portal.acm.org/citation.cfm?id=575722

• Friedman, CP. (2009). A “Fundamental theorem” of biomedical informatics. Journal of the American Medical Informatics . Retrieved from http://jamia.bmj.com/content/16/2/169.short

• Gorman, PN. (1995) Information needs of physicians. Journal of the American Society for Information Science and Technology

• Hunter, KM. Doctors' (1991) stories: The narrative structure of medical knowledge. Princeton University Press (1991)

• Kassirer, P and Kopelman, I. Learning clinical reasoning. pp. 332.• Tumulty, Philip A., (nd.) Quotation. “Disease hides its secrets in a casual parenthesis”

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Charts, Tables, References

• 4.1 Table: Types of information that clinicians utilize when making decisions• 4.2 Table: Comparison of the classic paradigm with the operating room.• 4.3 Table: Comparison of the classic paradigm with the operating room and acute complex illness.• 4.4 Table: Comparison of the classic paradigm with the operating room, acute complex illness and emergency

dept.