This presentation addresses evidence-based care and the EHR. It covers designing and delivering education and training programs aimed at accomplishing best practice clinical informatics models throughout healthcare organizations. Learner Outcome #1: The learner will obtain an understanding of the importance of the relationship between EHR functionality and guiding evidence-based care at the bedside. Learner Outcome #2: The learner will walk away with governance and processes of engaging clinicians in the evidence-based content customization process Learner Outcome #3: The learner will be familiar with the advantages of built in evidence-based care guidance within the EHR

1. INTEGRATED CARE GUIDANCE
Clyde E. Wesp, Jr., MD, MAOM
Executive Clinical Strategist
Jacobus Consulting

2. 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

3. TODAY’S AGENDA
■ Why
■ Vocabulary
■ Care Guidance in action
■ The future of Healthcare Informatics
■ Questions

4. QUESTION # 1
■ Has there been a time when you made a decision based
upon incomplete information?

5. WHERE ARE WE GOING TO BEGIN?

7. 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

8. 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

9. 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?

10. 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

11. 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)

12. 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)

13. PROCESS OF CARE
Evidence
based
medicine
Clinical
Decision
Support
Care
Guidance at
point of care
• Research
• Science
• Publications
• Application of EBM
• Add Experience
• Electronic Tools
• Content
• Workflow
• Alert Logic

14. 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

15. 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

16. 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

17. WHAT MAKES A CDS SYSTEM?

18. 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

19. MEDITECH INTEGRATION FOR CLINICAL
CONTENT
• Eliminates need for manual build.
• Significantly reduces time to deploy.
• Provides automatic access to a
comprehensive set of clinical content.
Speeds time
to go live
• Reduces people resources required to
deploy.
• Streamlines approach to customization.
Reduces
people
resources
REDUCING DEPLOYMENT TIME, COST AND RESOURCES

20. MEDITECH INTEGRATION FOR CLINICAL
CONTENT
• Includes content update and maintenance
program.
• Ensures content remains aligned with strategic
goals.
Ensures
Content
Remains
Current
• Drives evidence-based care to point of care.
• Standardizes clinical content and increases
clinical adoption.
• Demonstrates compliance with regulatory and
accreditation organizations.
Optimizes
time to
benefits
INCORPORATING STANDARDIZED ORDER SETS,
CARE PLANS, PHARMACY

21. 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

22. NOT INTEGRATED INTO THE WORKFLOW

23. 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.

24. 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?

25. QUESTION # 2
■ Has there been a time in your
organization that the right hand
did not know what the left hand
was doing?

26. CARE COORDINATION DEFINED?

27. CARE COORDINATION
Pharmacy
Medical
Office
Home
Nursing Home
Hospital
Doctors Nurses
Care Managers

28. REVIEW
Enhances the functionality of the EHR
Immediate feedback to the clinician promoting safety
Integrates documented data into decision making process
Sets up for mobile devices
28

29. “No one has the ability to capture
and analyze data from the future.
However, there is a way to
predict the future using data from
the past.
It’s called predictive analytics,
and organizations
do it every day.”

30. PREDICTIVE ANALYTICS
THE NEXT STEP
7/8/201530

31. 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