“So preventive care gets pushed aside for acute care issues?”
Physician: “Absolutely. That’s the nature of primary care.”
Physician: “Preventive care is the first thing to go when you’re busy.”
Physician: “When you’re in the middle of seeing patients, the last thing you want to do is address a preventive care issue.”
The Business of Genomic Testing by James CrawfordKnome_Inc
View this webinar at: http://www.knome.com/webinar-business-of-genomic-testing. This presentation discusses the findings of a College of American Pathologists survey of “early adopters” of NGS recently published in "Genetics in Medicine". The study objective was to identify the reasons for health systems to bring next-generation sequencing into their clinical laboratories and to understand the process by which such decisions were made. A standardized open-ended interview was conducted with the laboratory medical directors and/or department of pathology chairs of 13 different academic institutions in 10 different states.
The De-Identification of a Large Electronic Medical Records Database for Seco...Luk Arbuckle
Over the last decade Canada has seen extensive reforms, investments, and innovations in primary health care. The Canadian Working Group for Primary Healthcare Improvement recommended that performance reporting be a strategic priority in moving towards transforming the primary health care system. To enable scalable and sustainable performance measurement and reporting, automated data collection from electronic medical records (EMR) will be necessary. EMR data can also play an important role in adverse drug event detection and public health surveillance.
Best Practices for a Data-driven Approach to Test UtilizationViewics
Would you like to learn how data-driven interventions can improve laboratory test utilization in your organization? Would you like to hear about the impact that leading hospitals/health systems and managed care organizations have made through these interventions?
If so, you might be interested in this presentation by utilization management expert Dr. Michael Astion, Medical Director at the Department of Laboratories at Seattle Children’s Hospital and Clinical Professor of Laboratory Medicine at the University of Washington.
In this presentation, Dr. Astion discusses the current state of the misuse of laboratory testing in the United States and some of the interventions that are being implemented to improve it. He covers a number of common areas of unnecessary testing — from pure abuse to tests that could be useful but are ordered inappropriately.
You'll learn about:
• Two areas of laboratory testing where misordering of tests occur frequently
• Three interventions to improve the value of testing for patients
• The role of genetic counselors and other laboratory professionals in improving lab test ordering
• The national endeavor known as PLUGS, the Pediatric Laboratory Utilization Guidance Service
Advanced Laboratory Analytics — A Disruptive Solution for Health SystemsViewics
As US healthcare systems grapple with the recent upheavals in care payment and delivery, they are turning to advanced analytics as their “central nervous systems” for driving care and financial performance.
Laboratory information — spanning chemistry, pathology, microbiology and molecular testing, for example — is among the best sources of data for these advanced analytics, including clinician decision support, predictive analytics, population health management, and personalized medicine. When strategically harnessed and integrated to create a patient-centric lab data lake, laboratory information can form an affordable yet competitively powerful advanced analytics solution well suited for many health systems — i.e., a disruptive option.
L. Eleanor J. Herriman, MD, MBA, Chief Medical Informatics Officer of Viewics, explains why laboratory data should be a core strategic component for achieving success in value-based healthcare.
The Business of Genomic Testing by James CrawfordKnome_Inc
View this webinar at: http://www.knome.com/webinar-business-of-genomic-testing. This presentation discusses the findings of a College of American Pathologists survey of “early adopters” of NGS recently published in "Genetics in Medicine". The study objective was to identify the reasons for health systems to bring next-generation sequencing into their clinical laboratories and to understand the process by which such decisions were made. A standardized open-ended interview was conducted with the laboratory medical directors and/or department of pathology chairs of 13 different academic institutions in 10 different states.
The De-Identification of a Large Electronic Medical Records Database for Seco...Luk Arbuckle
Over the last decade Canada has seen extensive reforms, investments, and innovations in primary health care. The Canadian Working Group for Primary Healthcare Improvement recommended that performance reporting be a strategic priority in moving towards transforming the primary health care system. To enable scalable and sustainable performance measurement and reporting, automated data collection from electronic medical records (EMR) will be necessary. EMR data can also play an important role in adverse drug event detection and public health surveillance.
Best Practices for a Data-driven Approach to Test UtilizationViewics
Would you like to learn how data-driven interventions can improve laboratory test utilization in your organization? Would you like to hear about the impact that leading hospitals/health systems and managed care organizations have made through these interventions?
If so, you might be interested in this presentation by utilization management expert Dr. Michael Astion, Medical Director at the Department of Laboratories at Seattle Children’s Hospital and Clinical Professor of Laboratory Medicine at the University of Washington.
In this presentation, Dr. Astion discusses the current state of the misuse of laboratory testing in the United States and some of the interventions that are being implemented to improve it. He covers a number of common areas of unnecessary testing — from pure abuse to tests that could be useful but are ordered inappropriately.
You'll learn about:
• Two areas of laboratory testing where misordering of tests occur frequently
• Three interventions to improve the value of testing for patients
• The role of genetic counselors and other laboratory professionals in improving lab test ordering
• The national endeavor known as PLUGS, the Pediatric Laboratory Utilization Guidance Service
Advanced Laboratory Analytics — A Disruptive Solution for Health SystemsViewics
As US healthcare systems grapple with the recent upheavals in care payment and delivery, they are turning to advanced analytics as their “central nervous systems” for driving care and financial performance.
Laboratory information — spanning chemistry, pathology, microbiology and molecular testing, for example — is among the best sources of data for these advanced analytics, including clinician decision support, predictive analytics, population health management, and personalized medicine. When strategically harnessed and integrated to create a patient-centric lab data lake, laboratory information can form an affordable yet competitively powerful advanced analytics solution well suited for many health systems — i.e., a disruptive option.
L. Eleanor J. Herriman, MD, MBA, Chief Medical Informatics Officer of Viewics, explains why laboratory data should be a core strategic component for achieving success in value-based healthcare.
Tackling the U.S. Healthcare System’s Infectious Disease Management ProblemViewics
The United States healthcare system has a serious infectious disease management problem. The antibiotic resistance crisis is widespread, serious, costly, and deadly. Delays in pathogen identification lead to poor clinical outcomes, including increased mortality risk. And, optimally managing outbreaks is critical to health systems whose reimbursement is tied to the health of a population, such as ACOs.
Eleanor Herriman, MD, MBA, Chief Medical Informatics Officer at Viewics led an informative panel discussion with industry leaders on the issues surrounding the infectious disease management crisis. Margret Oethinger, MD, Ph.D., Medical Director of Providence Health & Services, and Susan E. Sharp, Ph.D., DABMM, FAAM, Regional Director of Microbiology and the Molecular Infectious Disease Laboratories, Department of Pathology, Kaiser Permanente and President-Elect, American Society for Microbiology cover the current state of infectious disease management in the U.S., and what can be done to improve it.
You’ll learn about:
• The magnitude of the U.S. health system’s infectious disease management problem
• The most serious concerns and trends for healthcare institutions and communities across the nation
• The most promising solutions to health systems’ most urgent infectious disease management challenges
Revolutionizing Renal Care With Predictive Analytics for CKDViewics
Chronic Kidney Disease (CKD) is a common and growing condition, affecting about half of the Medicare population and of diabetics. In the United States, the lifetime risk of CKD for 30-year-olds is now greater than half, and the prevalence of CKD is projected to rise significantly over the next 15 years.
Current methods of predicting which CKD patients will progress to renal failure and require dialysis or transplant have low accuracy rates, causing great anxiety and suboptimal care. Without accurate risk prediction, many patients are over-treated, effectively wasting limited resources and negatively impacting outcomes. Conversely, other patients may receive inadequate treatment, restricting options to only the most costly and least desirable interventions.
Watch this on-demand webinar with Dr. Navdeep Tangri, developer of the Kidney Failure Risk Equation, which revolutionizes the way CKD patients are managed by leveraging laboratory data to accurately predict the risk of kidney failure in patients with CKD.
You’ll learn:
• How CKD is burdening our healthcare system, and the need for better care management tools
• How the Kidney Failure Risk Equation was researched, developed, and validated
• How Viewics is implementing CKD predictive analytics to automatically deliver risk information to clinicians and issue customized, educational reports to patients and clinicians
Advanced Lab Analytics for Patient Blood Management ProgramsViewics
Reports indicate that 30 – 70% of blood transfusions are inappropriate. Inappropriate blood transfusions put patients at increased risk of post-surgical infections, multi-system organ failure, longer hospital stays, and higher mortality rates. The transfusion guidelines most clinicians learned in their training are now outdated. As such, blood transfusion practices vary widely, and overutilization remains a major quality and cost problem.
Patient Blood Management (PBM) programs are designed to optimize the use of transfusions through a team-based approach, evidence-based guidelines, and algorithms that together guide decisions regarding specifically which patients and clinical procedures warrant blood products, and how much to transfuse. PBM programs have been quite successful in improving patient morbidity and mortality outcomes and generating millions of dollars in savings for hospitals.
Laboratory analytics can be an effective means of instituting restrictive transfusion programs, and advanced lab analytics can be critical in implementing PBM programs, as lab testing and tracking blood usage is central to decision making, changing behavior, and improving performance.
Watch a presentation by Dr. Eleanor Herriman, Chief Medical Informatics Officer at Viewics. She unveils a new suite of advanced analytics tools that support PBS and other restrictive blood management programs, enabling health systems to better leverage their valuable lab medicine assets and fully integrate this key service line into these programs.
You’ll learn:
• How inappropriate blood transfusions are burdening our healthcare system, and the need for better utilization management tools
• New guidelines restricting red blood cell transfusions
• The role of advanced lab analytics in PBM programs
• How Viewics is leveraging advanced lab analytics to help health systems more easily and cost-effectively implement PBM programs
How Clinical Decision Support Systems (CDSS) is the right tool for physicians?Eurostars Programme EUREKA
We believe that CDSS delivered using information systems, ideally with the electronic medical record as the platform, will finally provide decision makers with tools making it possible to achieve large gains in performance, narrow gaps between knowledge and practice, and improve safety.
To address family history collection, interpretation, and application in busy primary care practices, NCHPEG has collaborated collaborating with the March of Dimes, Genetic Alliance, Harvard Partners, and the Health Resources and Services Administration to develop and evaluate a novel family history tool that focuses on prenatal and neonatal health. The tool helps to improve health outcomes for the female patient, fetus, and family by providing clinical decision support and educational resources for risk assessment based on family history. A set of screenshots and an overview of the module can be reviewed via this downloadable ppt.
Using the Bigtown Simulation Model to Predict the Impact of Enhanced Seven Day Services on Hospital Performance and Patient Outcomes
Poster from the 'Delivering NHS services, seven days a week' event held in Birmingham on 16 November 2013
More information about this event can be found at
http://www.nhsiq.nhs.uk/news-events/events/nhs-services-seven-days-a-week.aspx
Decision Support System for clinical practice created on the basis of the Un...blejyants
The company Socmedica developing an expert system of decision support for medical information systems. The product is aimed at solving the problem of medical errors.
SVMPharma Real World Evidence - Randomised controlled trials were never desig...SVMPharma Limited
SVMPharma Real World Evidence - Conventional RCTs are necessary for determining efficacy and safety, but real-world clinical practice can be very different. RWE complements RCT data and offers the opportunity to bridge the data gaps.
Have you identified your data gaps? For more information and resources visit us at www.svmpharma.com
Our presentation at AMIA about our regional MRSA collaborative and use of health information technology to share MRSA colonization and infection data electronically.
Tackling the U.S. Healthcare System’s Infectious Disease Management ProblemViewics
The United States healthcare system has a serious infectious disease management problem. The antibiotic resistance crisis is widespread, serious, costly, and deadly. Delays in pathogen identification lead to poor clinical outcomes, including increased mortality risk. And, optimally managing outbreaks is critical to health systems whose reimbursement is tied to the health of a population, such as ACOs.
Eleanor Herriman, MD, MBA, Chief Medical Informatics Officer at Viewics led an informative panel discussion with industry leaders on the issues surrounding the infectious disease management crisis. Margret Oethinger, MD, Ph.D., Medical Director of Providence Health & Services, and Susan E. Sharp, Ph.D., DABMM, FAAM, Regional Director of Microbiology and the Molecular Infectious Disease Laboratories, Department of Pathology, Kaiser Permanente and President-Elect, American Society for Microbiology cover the current state of infectious disease management in the U.S., and what can be done to improve it.
You’ll learn about:
• The magnitude of the U.S. health system’s infectious disease management problem
• The most serious concerns and trends for healthcare institutions and communities across the nation
• The most promising solutions to health systems’ most urgent infectious disease management challenges
Revolutionizing Renal Care With Predictive Analytics for CKDViewics
Chronic Kidney Disease (CKD) is a common and growing condition, affecting about half of the Medicare population and of diabetics. In the United States, the lifetime risk of CKD for 30-year-olds is now greater than half, and the prevalence of CKD is projected to rise significantly over the next 15 years.
Current methods of predicting which CKD patients will progress to renal failure and require dialysis or transplant have low accuracy rates, causing great anxiety and suboptimal care. Without accurate risk prediction, many patients are over-treated, effectively wasting limited resources and negatively impacting outcomes. Conversely, other patients may receive inadequate treatment, restricting options to only the most costly and least desirable interventions.
Watch this on-demand webinar with Dr. Navdeep Tangri, developer of the Kidney Failure Risk Equation, which revolutionizes the way CKD patients are managed by leveraging laboratory data to accurately predict the risk of kidney failure in patients with CKD.
You’ll learn:
• How CKD is burdening our healthcare system, and the need for better care management tools
• How the Kidney Failure Risk Equation was researched, developed, and validated
• How Viewics is implementing CKD predictive analytics to automatically deliver risk information to clinicians and issue customized, educational reports to patients and clinicians
Advanced Lab Analytics for Patient Blood Management ProgramsViewics
Reports indicate that 30 – 70% of blood transfusions are inappropriate. Inappropriate blood transfusions put patients at increased risk of post-surgical infections, multi-system organ failure, longer hospital stays, and higher mortality rates. The transfusion guidelines most clinicians learned in their training are now outdated. As such, blood transfusion practices vary widely, and overutilization remains a major quality and cost problem.
Patient Blood Management (PBM) programs are designed to optimize the use of transfusions through a team-based approach, evidence-based guidelines, and algorithms that together guide decisions regarding specifically which patients and clinical procedures warrant blood products, and how much to transfuse. PBM programs have been quite successful in improving patient morbidity and mortality outcomes and generating millions of dollars in savings for hospitals.
Laboratory analytics can be an effective means of instituting restrictive transfusion programs, and advanced lab analytics can be critical in implementing PBM programs, as lab testing and tracking blood usage is central to decision making, changing behavior, and improving performance.
Watch a presentation by Dr. Eleanor Herriman, Chief Medical Informatics Officer at Viewics. She unveils a new suite of advanced analytics tools that support PBS and other restrictive blood management programs, enabling health systems to better leverage their valuable lab medicine assets and fully integrate this key service line into these programs.
You’ll learn:
• How inappropriate blood transfusions are burdening our healthcare system, and the need for better utilization management tools
• New guidelines restricting red blood cell transfusions
• The role of advanced lab analytics in PBM programs
• How Viewics is leveraging advanced lab analytics to help health systems more easily and cost-effectively implement PBM programs
How Clinical Decision Support Systems (CDSS) is the right tool for physicians?Eurostars Programme EUREKA
We believe that CDSS delivered using information systems, ideally with the electronic medical record as the platform, will finally provide decision makers with tools making it possible to achieve large gains in performance, narrow gaps between knowledge and practice, and improve safety.
To address family history collection, interpretation, and application in busy primary care practices, NCHPEG has collaborated collaborating with the March of Dimes, Genetic Alliance, Harvard Partners, and the Health Resources and Services Administration to develop and evaluate a novel family history tool that focuses on prenatal and neonatal health. The tool helps to improve health outcomes for the female patient, fetus, and family by providing clinical decision support and educational resources for risk assessment based on family history. A set of screenshots and an overview of the module can be reviewed via this downloadable ppt.
Using the Bigtown Simulation Model to Predict the Impact of Enhanced Seven Day Services on Hospital Performance and Patient Outcomes
Poster from the 'Delivering NHS services, seven days a week' event held in Birmingham on 16 November 2013
More information about this event can be found at
http://www.nhsiq.nhs.uk/news-events/events/nhs-services-seven-days-a-week.aspx
Decision Support System for clinical practice created on the basis of the Un...blejyants
The company Socmedica developing an expert system of decision support for medical information systems. The product is aimed at solving the problem of medical errors.
SVMPharma Real World Evidence - Randomised controlled trials were never desig...SVMPharma Limited
SVMPharma Real World Evidence - Conventional RCTs are necessary for determining efficacy and safety, but real-world clinical practice can be very different. RWE complements RCT data and offers the opportunity to bridge the data gaps.
Have you identified your data gaps? For more information and resources visit us at www.svmpharma.com
Our presentation at AMIA about our regional MRSA collaborative and use of health information technology to share MRSA colonization and infection data electronically.
Taking Transformational Change To Scale.Doebbeling.3.9.10.FinalBrad Doebbeling
Taking transformational change to scale:Reducing MRSA and other infections.
5th National Pay for Performance Summit:
Mini Summit IV: Tools and Strategies to Support Transformational Change
San Francisco, CA, March 8-10, 2010
Outline of ideas to advance the science of transforming health care organizations. 81. “Advancing Transformational Science”, Bridges to Sustainable Healthcare Transformation Through Evidence, Partnerships & Technology: 19th International Conference San Francisco, CA, January 19-22, 2011.
Iu Ahrq Hai Assessment Ctr Presentation Feb 22 2010 FinalBrad Doebbeling
75. Healthcare Associated Infections: Assessment Center Findings , Invited Talk, NCQIP, Agency for Healthcare Research and Quality, Bethesda, MD, February 22, 2010.
Provider perspectives on the utility of a colorectalcancer s.docxwoodruffeloisa
Provider perspectives on the utility of a colorectal
cancer screening decision aid for facilitating shared
decision making
Paul C. Schroy III MD MPH,* Shamini Mylvaganam MPH� and Peter Davidson MD�
*Director of Clinical Research, Section of Gastroenterology, Boston Medical Center, Boston, MA, �Study Coordinator, Section of
Gastroenterology, Boston Medical Center, Boston, MA and �Clinical Director, Section of General Internal Medicine, Boston
Medical Center, Boston, MA, USA
Correspondence
Paul C. Schroy III, MD MPH
Boston Medical Center
85 E. Concord Street
Suite 7715
Boston
MA 02118
USA
E-mail: [email protected]
Accepted for publication
8 August 2011
Keywords: decision aids, informed
decision making, shared decision
making
Abstract
Background Decision aids for colorectal cancer (CRC) screening
have been shown to enable patients to identify a preferred screening
option, but the extent to which such tools facilitate shared decision
making (SDM) from the perspective of the provider is less well
established.
Objective Our goal was to elicit provider feedback regarding the
impact of a CRC screening decision aid on SDM in the primary care
setting.
Methods Cross-sectional survey.
Participants Primary care providers participating in a clinical trial
evaluating the impact of a novel CRC screening decision aid on
SDM and adherence.
Main outcomes Perceptions of the impact of the tool on decision-
making and implementation issues.
Results Twenty-nine of 42 (71%) eligible providers responded,
including 27 internists and two nurse practitioners. The majority
(>60%) felt that use of the tool complimented their usual approach,
increased patient knowledge, helped patients identify a preferred
screening option, improved the quality of decision making, saved
time and increased patients� desire to get screened. Respondents
were more neutral is their assessment of whether the tool improved
the overall quality of the patient visit or patient satisfaction. Fewer
than 50% felt that the tool would be easy to implement into their
practices or that it would be widely used by their colleagues.
Conclusion Decision aids for CRC screening can improve the
quality and efficiency of SDM from the provider perspective but
future use is likely to depend on the extent to which barriers to
implementation can be addressed.
doi: 10.1111/j.1369-7625.2011.00730.x
� 2011 John Wiley & Sons Ltd 27
Health Expectations, 17, pp.27–35
Introduction
Engaging patients to participate in the decision-
making process when confronted with prefer-
ence-sensitive choices related to cancer screening
or treatment is fundamental to the concept of
patient-centred care endorsed by the Institute of
Medicine, US Preventive Services Task Force
and the Centers for Disease Control and Pre-
vention.
1–3
Ideally, this process should occur
within the context of shared decision making
(SDM), whereby patients and their health-care
providers form a partnershi ...
Module 5 (week 9) - InterventionAs you continue to work on your .docxroushhsiu
Module 5 (week 9) - Intervention
As you continue to work on your assignment, you will be pulling in some information from your work throughout this course. For one part of this presentation, you will be identifying the current problem (or opportunity for change). This was part of your discussion in the week 2 assignment PowerPoint.
You will also propose an evidence-based intervention to address this particular problem. This intervention should be derived from the literature you have found and presented in your critical appraisal template.
As you have seen, these assignments have provided you the ability to identify a problem, develop a PCIOT question, search for evidence related to this PICOT, critically appraise the evidence for a solution to the problem, and now you will identify the solution and disseminate the results.
You are well on your way to becoming evidence-based practitioners!
Week 9!
Nice work on last week’s discussion. As you have discovered, decision aids can be very helpful when providing information for patients and families.
This week, you will continue to work on your assignment for this module. This will be an 8-9 slide PowerPoint presentation in which you will recommend an evidence-based practice change. Review the 4 articles you critiqued to determine what practice change is supported by the literature.
Some of the content for this assignment will be taken from your previous work and some will be new. This PowerPoint is a total of 8-9 slides.
Please review the full assignment details located under the learning resources for module 5.
Please let me know if you have questions
David
Provider perspectives on the utility of a colorectal
cancer screening decision aid for facilitating shared
decision making
Paul C. Schroy III MD MPH,* Shamini Mylvaganam MPH� and Peter Davidson MD�
*Director of Clinical Research, Section of Gastroenterology, Boston Medical Center, Boston, MA, �Study Coordinator, Section of
Gastroenterology, Boston Medical Center, Boston, MA and �Clinical Director, Section of General Internal Medicine, Boston
Medical Center, Boston, MA, USA
Correspondence
Paul C. Schroy III, MD MPH
Boston Medical Center
85 E. Concord Street
Suite 7715
Boston
MA 02118
USA
E-mail: [email protected]
Accepted for publication
8 August 2011
Keywords: decision aids, informed
decision making, shared decision
making
Abstract
Background Decision aids for colorectal cancer (CRC) screening
have been shown to enable patients to identify a preferred screening
option, but the extent to which such tools facilitate shared decision
making (SDM) from the perspective of the provider is less well
established.
Objective Our goal was to elicit provider feedback regarding the
impact of a CRC screening decision aid on SDM in the primary care
setting.
Methods Cross-sectional survey.
Participants Primary care providers participating in a clinical trial
evaluating the impact of a novel CRC screening d ...
How general internists can participate in the continuum of care for patients with cancer. (Talk given at Internal Medicine Grand Rounds, St. Elizabeth Hospital, General Santos City, 10 Feb 2021.)
Though a recent study found repeat colonoscopy is good for certain patients, accurate documentation is still a crucial factor to determine whether it is appropriate.
Decision makers in the healthcare field like doctors, patients and policy makers need access to clinical evidence to address issues that have bearing on the health of the population and the treatment prescribed and thereby on the financials implications of the healthcare industry.
Dionisio Acosta: Clinical decision support systems
Investigating Integration Of Computerized Decision Support Into Workflow Hsr&D Pres Feb 17 2011
1. Investigating Integration of Computerized Decision Support into Workflow at 3 Benchmark Institutions February 17th, 2011 Doebbeling B.N., Haggstrom, D.A., Militello, L.G., Flanagan, M.E., Arbuckle, C.L., Kiess, C.L., Saleem, J.J. VA HSR&D Center on Implementing Evidence-Based Practice; Regenstrief Institute; IU School of Medicine and Purdue School of Engineering
2. Acknowledgements 2 Supported by: Agency for Healthcare Quality and Research (AHRQ) HSA2902006000131 Department of Veterans Affairs, VHA HSR&D CDA 09-024-1
3. Background 3 Colorectal cancer screening Low screening rates; evidence for screening effectiveness Clinical decision support (CDS) has been associated with improved quality However, the design and workflow integration of CDS may limit its impact Recent IOM Committee calling for new paradigm in cognitive support
4. Study Question 4 Barriers to colorectal cancer (CRC) screening and follow-up? Factors influencing integration into clinical workflow
5. Rationale for Study Sites “Benchmark institutions” for CDS Regenstrief Institute, Partners Healthcare, Veterans Health Administration, (Intermountain Health Care) Early-adopter institutions that implemented internally developed health information technology systems, including computerized CDS Widely implemented CDS in these institutions Ideal settings to study integration of CDS in workflow (Chaudhry et al, Ann Intern Med, 2006) Chaudhry et al., Ann Intern Med, 2006
6. Methods Cognitive Field Research Ethnographic observations Opportunistic interviews Study: CDS for colorectal cancer (CRC) screening in Primary care clinics 2 VAMCs 2 teaching hospitals (Regenstrief, Partners)
7. Form of CRC Screening CDS at Study Sites 7 VA Medical Center 1 Computerized clinical reminder for CRC screening VA Medical Center 2 Suite of computerized CDS for risk stratification, screening, follow-up, and surveillance Regenstrief Institute Paper encounter form reminder for CRC screening Partners Healthcare Electronic, template health maintenance list
10. Analyses 10 Coding template based on the sociotechnical model Social, technical, and external subsystems Qualitative analyses: top-down vs. bottom-up coding Summary and integrative findings Findings integrated across sites
11. Barriers to colorectal cancer screening and follow-up 11 Lack of communication of “outside” exam results Poor data organization & presentation Omission of provider, patient education in CDS Lack of interface flexibility Lack of coordination between primary care and GI Needed technological enhancements Unclear role assignments
12. % of Coded Segments in the Technical Sub-Section by Themes & Sites 12 Implementing and Improving the Integration of Decision Support into Outpatient Clinical Workflow, AHRQ ACTION HSA2902006000131
15. % of Coded Segments in the Technical Sub-Section by Themes & Sites 15
16. Practices and design features 16 1) organizational priorities; 2) contextual structure and process; 3) team role assignments & workflow; 4) coordination and communication between clinics and other services; 5) integrating outside results; 6) improved data organization, presentation; 7) just-in time patient education and provider cognitive support; 8) interface and user interaction; 9) technological enhancements.
17. Conclusions Despite differences between health systems, barriers were quite consistent. New CDS prototypes are needed which: 1) improve data organization and presentation; 2) integrate outside results and 3) provide just-in time education and cognitive support. Workflow variations, user-centered design and usability key to an information system that works in practice. Effective design and integration of new technologies requires mindful iteration.
18. Thank-you! 18 Haggstrom DA, Saleem JJ, Militello LG, Arbuckle N, Flanagan M, Doebbeling BN. Examining the relationship between clinical decision support and performance measurement. Proc AMIA Symp 2009; 223-7. Saleem JJ, Militello LG, Arbuckle N, Flanagan M, Haggstrom DA, Linder JA, Doebbeling BN. Provider perceptions of colorectal cancer screening decision support at three benchmark institutions. Proc AMIA Symp 2009; 558-62.
20. Form of Colorectal Cancer Screening CDS at Study Sites 20 VA Medical Center 1 Computerized clinical reminder for CRC screening VA Medical Center 2 Set of computerized clinical reminders for screening, follow-up, and surveillance Regenstrief Institute Paper encounter form reminder for CRC screening Partners Healthcare Electronic, template health maintenance list
21. Form of Colorectal Cancer Screening CDS at Study Sites 21 VA Medical Center 1 Computerized clinical reminder for CRC screening VA Medical Center 2 Set of computerized clinical reminders for screening, follow-up, and surveillance Regenstrief Institute Paper encounter form reminder for CRC screening Partners Healthcare Electronic, template health maintenance list
22. Regenstrief Medical Record System 22 Printed paper encounter form with clinical reminders at the bottom. Paper reminders automatically generated by the CDS rules. * Annual FOBT and periodic sigmoidoscopy are recommended for all persons aged 50 or over to screen for colorectal cancer. If screening FOBT is positive, colonoscopy is recommended. * HEMOCCULT 1)Pt refused 2) Done Today (results: ___________________)
23. Form of Colorectal Cancer Screening CDS at Study Sites 23 VA Medical Center 1 Computerized clinical reminder for CRC screening VA Medical Center 2 Set of computerized clinical reminders for screening, follow-up, and surveillance Regenstrief Institute Paper encounter form reminder for CRC screening Partners Healthcare Electronic, template health maintenance list
25. Receiving and documenting “outside” exam results 25 Physician: “In the [CRC] clinical reminder [dialog] box you cannot easily document that a colonoscopy was done outside of the VA. Say the patient had an outside colonoscopy done 5 years ago- you need to enter the exact date, time, location. But the patient may only remember that he had a colonoscopy about 5 years ago.”
26. Colorectal cancer screening CDS not accurate 26 Physician: “One patient was sent to GI three times for a colonoscopy. Each time they told him he wasn’t due. But the reminder keeps coming up. He had a colonoscopy recently, so I don’t know why the reminder doesn’t turn off.”
27. Compliance issues 27 Physician: “They did it wrong up front – they completed the colorectal cancer screening reminder wrong. It [the reminder] says the cards were given to the patient but she [health tech] did not give him the cards. Every system has weak links. This is one of them for us.”
28. Poor EHR or CDS usability 28 Physician Assistant Paper spreadsheet to track date and results for colonoscopies Nurse Practitioner Need to repeat screening
29. Lack of coordination between primary care and GI 29 Physician: “GI should be able to clear out the [computerized clinical] reminder. For example, the patient we just saw…it took me a while to go through and satisfy it [the CRC clinical reminder]. The patients see lots of different people in the hospital and they all have their hands in the patient’s care. They should be satisfying some of the reminders as well.”
30. Acute vs. preventive care 30 Physician: “If I have to choose between chest pain and hemoccult [fecal occult blood test], I am going to choose chest pain.”
Editor's Notes
Two studies of the integration of clinical decision support tools Two days of observation at each site2-3 observers at each siteEach observer stayed with one provider through an average of two CDS interactions before observing another providerData analyzed using upward abstraction
Site 3 had a tool focused on coordination of care between primary and specialty careSite 2 had much on paper-electronic blend—had greatest use of paperSite 4 (PH) had more comments about functionality—was that related to positive or negative comments—comparable in advanced IT development to VA, but smaller system—huge IT research dept colocated with themUsability comments comparable across the sites similar even though very different systems—most were negativeLowest site on usability (RI) had templates, fewest negative commetns on usability probably related to using less for their jobRigidity—computer system, electronic medical record—forced you to do things, computer systemSite 1 and 3 had highest comments about rigidity (VA’s) and centrally controlled development strategyCoordination between specialty and primary care—tool developed as joint effort between primary and specialty care to foster scheduling, intake and provider and specialty and provider. Here coordination between intake and provider removed.Make a list of interpretations—do this again after we create figure from card sort and recommendations.
Interesting predominance of comments on technical system—is there an imbalance on technologically driven system, or was that the focus of the observations?Site 1 West HavenSite 2 RISite 3 Columbia VASite 4 PartnersCould this reflect frequency due to additional capturing of codesSite 1 had 2 peopleSite 2 had 3 peopleBig other data so detailed and made a point of recording all data regarding other stuff observed—for example, any time CRC mentioned, coded as other.Revised slide with only observations that were coded end of FTF session…1 page list of most important results and themesCreate graph of that card sort…4 recommendations that fell under the card sort, show proportion by siteMade up of codes under each of those strategies
Site 3 had a tool focused on coordination of care between primary and specialty careSite 2 had much on paper-electronic blend—had greatest use of paperSite 4 (PH) had more comments about functionality—was that related to positive or negative comments—comparable in advanced IT development to VA, but smaller system—huge IT research dept colocated with themUsability comments comparable across the sites similar even though very different systems—most were negativeLowest site on usability (RI) had templates, fewest negative commetns on usability probably related to using less for their jobRigidity—computer system, electronic medical record—forced you to do things, computer systemSite 1 and 3 had highest comments about rigidity (VA’s) and centrally controlled development strategyCoordination between specialty and primary care—tool developed as joint effort between primary and specialty care to foster scheduling, intake and provider and specialty and provider. Here coordination between intake and provider removed.Make a list of interpretations—do this again after we create figure from card sort and recommendations.