1. Egypt: Health IT and Clinical Decision
Support
C. William Hanson III MD

2. Feedback loop: Decision Support and Data
CDS
CDS
(tailored health info
(best practice guidelines)
for pts/pops)
ALERTS ALERTS
Realtime dashboard Realtime dashboard
(provider/population level) (pt/pop level)
2

3. Core competencies of a Health System
Desired Core
Characteristics of the “Best Prepared”
Competencies
Physician A highly aligned medical staff characterized by outcome-based contractual arrangements,
Integration (pg. 6) collaborative planning, and adequate representation in organizational governance.
Care Coordination Use of care coordination tools and processes by an empowered and integrated workforce to meet
(pg. 7) performance goals that are regularly measured and reported.
Cost Management A right-sized organization-wide cost structure highlighted by appropriate levels of staffing, capital
(pg. 8) spend and supply chain costs constantly reviewed based on comparative peer group studies and
benchmarks.
Information An enterprise-wide IT platform that supports clinical and business decision making, information
Systems management and utilization, access by all stakeholders (physicians, patients, administration).
Sophistication (pg. 9)
Balanced Service A rational service distribution system that has accessible primary care, easy access across the
Distribution (pg. 10) care continuum and is based on contemporary facilities and equipment; minimal clinical service
duplication across the system.
Payor Maintaining strong relationships with payers and having the ability to negotiate support for “new-
Relationships/ era” contract terms/mechanisms, as well as influence product design.
Contracts (pg. 11)
Financial/Capital Strong appeal to capital markets through sustained strength in operations, revenue growth,
Capacity (pg. 12) profitability, liquidity and balance sheet strength.
Scale/ Sufficient scale in the market to attract competitive clinical and administrative talent, realize
Essentiality (pg. 13) operating and capital economies, drive marketplace innovation and be an essential provider to
health plans and patients; optimal portfolio of business units, service lines, and assets that permit
the System to achieve its organizational goals and reflect the emerging model for the delivery of
care.
Source: Kaufman, Hall & Associates, Inc. Reproduced, and modified, with permission 3

4. Using the Five Rights of CDS to Improve Outcomes at Penn
THE FIVE RIGHTS HOW WE ARE DOING IT WHAT IT LOOKS LIKE
AT PENN MEDICINE
The Right Information… Requests are prioritized and Evidence-based, useful for
informed by reviews of the guiding action and answering
evidence questions
…to the Right Program Manager works with Both clinicians and patients
Stakeholder… requestor to ensure the right
stakeholders are involved
…in the Right Format… • Interventions are vetted Alerts, Order Sets,
through the CDS workgroup InfoButtons, etc.
•Technical and clinical
…through the Right expertise informs the Electronic medical record,
Channel… intervention designs internet, mobile devices
•The impact of all
…at the Right Point in the To influence key
interventions are measured
Workflow. decisions/actions
through reports
4

5. Passive DSS
“What
do you
think?”
5

6. Passive Decision Support
 Relevant Data Presentation
• Facilitate decision making
 Documentation forms/templates
• Enforce required data entry
 Order and Data Entry Forms
• Automated calculation
• Correct orders
• Present needed lab results
 Order Sets
• Group of orders related to a clinical condition (trauma, MI)
6

7. Expert systems (Mycin)
“Should I refer?”
7

8. Diagnostic DSS
8

9. Diagnostic DSS
9

10. Pathways
10

11. Semi-active DSS
“I’d suggest
the
following”
11

12. Order entry (drugs) with alerts
X
12

13. Order entry (radiology) Decision Support
If “Ignore” is selected, Peer-To-Peer screen is presented
13 13

14. 14 14

15. Active Decision Support
“So this is
what
I did”
15

16. Active Decision Support
 Urgent notice generated by the system
 Immediate notification of an error or hazard
recognized by the system based on new data or the
passage of time during which something should
have occurred (but didn’t)
16

17. DSS - Autonomous systems
 Automated medication administration
 AICD
17

18. AICD
18

19. Decision Support: Liability
19

20. Decision Support: Is it trustworthy?
“Apply
leeches and
let blood”
20

21. HOW DO YOU BUILD DSS?
21

22. Current State
IT Analyst
IT Report
CDS Workgroup Writer
Key
Stakeholders
Requestor
of CDS
Intervention CDS Program
Manager
CDS Workflow: 1 CDS Workflow: 2 CDS Workflow: 3 CDS Workflow: 4 CDS Workflow: 5 CDS Catalog
• Program • PM • PM works • PM presents • Revised CDS • Final scoping
Manager (PM) coordinates with IT staff to CDS is tested, document,
works with with to create a Workgroup finalized, and screen shots,
requestor to relevant
requestor draft CDS, for review slated for evidence
identify scope, report and and comment release reports, and
champions at content and education baseline and
each UPHS follow-up data
entity as reporting tool
needs catalogued
appropriate
22

23. Using the Five Rights of CDS to Improve Outcomes at Penn
THE FIVE RIGHTS HOW WE ARE DOING IT WHAT IT LOOKS LIKE
AT PENN MEDICINE
The Right Information… Requests are prioritized and Evidence-based, useful for
informed by reviews of the guiding action and answering
evidence questions
…to the Right Program Manager works with Both clinicians and patients
Stakeholder… requestor to ensure the right
stakeholders are involved
…in the Right Format… • Interventions are vetted Alerts, Order Sets,
through the CDS workgroup InfoButtons, etc.
•Technical and clinical
…through the Right expertise informs the Electronic medical record,
Channel… intervention designs internet, mobile devices
•The impact of all
…at the Right Point in the To influence key
interventions are measured
Workflow. decisions/actions
through reports
23

24. Development of DSS rule or alert (process)
24

25. Admission Order Set (CDS)
25

26. Urinary catheter CDS tool
26

27. Alerting and alert fatigue
 Alert
• Must be specific (patient)
• Must be targeted (provider, caregiver) at someone
who can act efficiently
• Must be timely and convenient
• Must come with relevant content
27

28. Epic drug alerts
28

29. Feedback loop: the patient
CDS
CDS
(tailored health info
(best practice guidelines)
for pts/pops)
ALERTS ALERTS
Realtime dashboard Realtime dashboard
(provider/population level) (pt/pop level)
29

30. Decision support for the patient
30

31. 31

32. 32

33. 33

34. Feedback loop: Decision Support and Data
CDS
CDS
(tailored health info
(best practice guidelines)
for pts/pops)
ALERTS ALERTS
Realtime dashboard Realtime dashboard
(provider/population level) (pt/pop level)
34

35. Data
35

36. Data visualization
36

37. Decision support for the leaders
Decision Making &
Analyze Action
Information
Decision Making &
Action
% Time Spent
Analyze
Information
Collect Data
Analyze
Information
Collect Data Collect Data
Classic Reporting BI & Analytic Tools First Generation EIM
Less Mature More Mature
37

38. Vision: Enterprise Analytics
- Cost per Case
- ALOS
- Quality Compliance
C-Level / Strategic Planning
• Cost savings opportunities by standardizing
material and implant choices
- Core Measures
• Case Volume by Specialty – market alignment
- ASA AQA
• Improve resource utilization; patient satisfaction - NSQIP
Executive Quality Department
User • Reduce costs by automating report development
• ID opportunities to reduce SSI’s, re-admits, ALOS
• Improve compliance with regulatory mandates
Functional User
Analyst / Informaticist/Service
Power User Leads/UBCL directors
• Analytic & reporting tools
- SCIP, PN, AMI
• Report development and distribution
- Beta-blocker
• Monitor data quality; standardize vocab. - Foley Catheter
- PNDS
The Right Information. To the Right People. At the Right Time.
38