Week 5: Clinical Decision Support
Clinical Decision Support (CDS)
Clinical decision support (CDS) as a process designed to aid directly in clinical decision making, in which characteristics of individual patients are used to generate patient specific interventions, assessments, recommendations, or other forms of guidance that are then presented to a decision-making recipient or recipients that can include clinicians, patients, and others involved in care delivery. CDS tools existed prior to development of EHRs. Historical examples include practice guidelines carried in clinicians’ pockets, patient cards used by providers to track a patient’s treatments, and tables of important medical knowledge. The primary goal of implementing a CDS tool is to leverage data and the scientific evidence to help guide appropriate decision making. CDS tools include but are not limited to:
Workflow Design
Workflow is a term used to describe the action or execution of a series of tasks in a prescribed sequence. Another definition of workflow is a progression of steps (tasks, events, interactions) that constitute a work process, involve two or more persons, and create or add value to the organization’s activities. In a sequential workflow, each step depends on the occurrence of the previous step; in a parallel workflow, two or more steps can occur concurrently. The term workflow is sometimes used interchangeably with process or process flows, particularly in the context of implementations. Observation and documentation of workflow to better understand what is happening in the current environment and how it can be altered is referred to as process or workflow analysis. A critical aspect of the informatics role is workflow design. Nursing informatics is uniquely positioned to engage in the analysis and redesign of processes and tasks surrounding the use of technology.
Clinical Decision Support Systems and Improving Healthcare Delivery
Clinical decision support systems (CDSSs) are quickly becoming essential tools for healthcare providers as the volume of available data increases alongside their responsibility to deliver value-based care (Castaneda et al., 2015). Reducing clinical variation and duplicative testing, ensuring patient safety, and avoiding complications that may result in expensive hospital readmissions are top priorities for providers in the modern regulatory and reimbursement environment – and harnessing the hidden insights of big data is essential for achieving these goals. CDSS tools are designed to help sift through enormous amounts of digital data to suggest next steps for treatments, alert providers to available information they may not have seen, or catch potential problems, such as dangerous medication interactions.
Integrating CDSS into electronic health records allows medication information to be combined with patient information to create alerts about drug-drug interactions, drug allergy contraindications, and other important situations Drug-drug interaction checking and drug-allergy checking are conceptually straightforward but can catch a critical source of human error that no amount of training or personal vigilance can eliminate. A CDSs is not simply an alert, notification, or explicit care suggestion.
Slightly more advanced CDSSs analyze clinical data and present guidance based on those data. More sophisticated systems look for trends in values, such as the rate of fall of the hematocrit or the rising weight of an ICU patient who is accumulating extracellular fluid, where an absolute number may not be notable, but an alert to the trend may be important and prompt action. Such sophisticated tools require oversight by federal regulation, which we will address in more detail in the Week 6 lesson.
Challenges to Implementing a CDSS
Decision support systems are challenging to implement and maintain. The most vexing problem is “alert fatigue’. Studies within and outside health care show the benefit of an alert, such as a pop-up interaction in a software system, is rapidly extinguished if the alert becomes a routine part of using the system. In practice, 49% to 96% of alerts are overridden, raising questions about the effectiveness of decision support (Ancker et al., 2017). Alert fatigue and clinical burnout are common byproducts of poorly implemented clinical decision support features that overwhelm users with unimportant information or frustrating workflow freezes that require extra clicks to circumvent. One study found that clinicians spend approximately 66.8 minutes per day processing notifications from EHR use. Fant and Adelman (2018) concluded alarm fatigue to be a significant burden for clinicians. Alert fatigue is a fact of human cognition and cannot be eliminated through training, education, or vigilance. The best clinical systems offer fine-grained tuning of the system’s behavior, such as altering the system’s response by drug and provider specialty and offer a range of interruptive and non-interruptive support mechanisms.
The financial implications to design and maintain informatics infrastructure is often costly for any institution. The most complex decision support systems attempt to aid clinical diagnosis. The application of artificial intelligence to medicine has a long history; however, most diagnostic expert systems have been stand-alone, requiring effort by the clinician outside of their normal workflow and have thus seen limited clinical implementation. Examples of clinical diagnostic systems directly imbedded in an electronic health record are few but are an area of increasing commercial interest.
Why Incorporate a CDSS with Practice?
The primary goal of a CDSS is to leverage data and the scientific evidence to help guide appropriate decision making. When looking at ways in which CDSS tools can be leveraged in a clinical process, the CDSS team needs to approach the project from a data-driven manner supported by the evidence. This requires in-depth analysis of the scientific evidence coupled with data-analysis methods to identify gaps in practice within the organization. It is equally important to identify where there are gaps in ability to report how an organization is doing with respect to patient care and if recommended practice guidelines are being followed. This would constitute absence of data captured to track that information. Often, these gaps or absence of data and information tell an organization where to focus with respect to adding where a CDSS tool should be. It is the role of the CDSS team to identify all the elements of a process and use data to identify areas where processes might be enhanced with the use of CDSS tools to provide users with the best evidence and to support appropriate decision making and treatment decisions (HIMSS, 2014).
Post a written response in the discussion forum to EACH threaded discussion topic:
- This week we learned about the potential benefits and drawbacks to clinical decision support systems (CDSSs). Create a “Pros” versus “Cons” table with a column for “Pro” and a separate column for “Con”. Include at least 3 items for each column. Next to each item, provide a brief rationale as to why you included it on the respective list.
- The primary goal of a CDSS is to leverage data and the scientific evidence to help guide appropriate decision making. CDSSs directly assist the clinician in making decisions about specific patients. For this discussion thread post, you are to assume your future role as an APN and create a clinical patient and scenario to illustrate an exemplary depiction of how a CDSS might influence your decision. This post is an opportunity for you to be innovative, so have fun!
Adhere to the following guidelines regarding quality for the threaded discussions in Canvas:
-
- Application of Course Knowledge: Demonstrate the ability to analyze, synthesize, and/or apply principles and concepts learned in the course lesson and outside readings.
- Scholarliness and Scholarly Sources: Demonstrates achievement of scholarly inquiry for professional and academic decisions using valid, relevant, and reliable outside scholarly source to contribute to the discussion thread.
- Writing Mechanics: Grammar, spelling, syntax, and punctuation are accurate. In-text and reference citations should be formatted using correct APA guidelines.
- Direct Quotes: Good writing calls for the limited use of direct quotes. Direct quotes in discussions are to be limited to one short quotation (not to exceed 15 words). The quote must add substantively to the discussion. Points will be deducted under the grammar, syntax, APA category.
For each threaded discussion per week, the student will select no less than TWO scholarly sources to support the initial discussion post.
Scholarly Sources: Only scholarly sources are acceptable for citation and reference in this course. These include peer-reviewed publications, government reports, or sources written by a professional or scholar in the field. The textbooks and lessons are NOT considered to be outside scholarly sources. For the threaded discussions and reflection posts, reputable internet sources such as websites by government agencies (URL ends in .gov) and respected organizations (often ends in .org) can be counted as scholarly sources. The best outside scholarly source to use is a peer-reviewed nursing journal. You are encouraged to use the Chamberlain library and search one of the available databases for a peer-reviewed journal article. The following sources should not be used: Wikipedia, Wikis, or blogs. These websites are not considered scholarly as anyone can add to these. Please be aware that .com websites can vary in scholarship and quality. For example, the American Heart Association is a .com site with scholarship and quality. It is the responsibility of the student to determine the scholarship and quality of any .com site. Ask your instructor before using any site if you are unsure. Points will be deducted from the rubric if the site does not demonstrate scholarship or quality. Current outside scholarly sources must be published with the last 5 years. Instructor permission must be obtained BEFORE the assignment is due if using a source that is older than 5 years.
| DISCUSSION CONTENT | |||
| Category | Points | % | Description |
| Application of Course Knowledge
|
50 | 33% | The quality for this category is determined by the ability to analyze, synthesize, and/or apply principles and concepts learned in the course lessons and outside readings and relate them to real-life professional situations. |
| Scholarliness and Scholarly Resources
|
40 | 27% | This category is evaluated on the quality of the student’s ability to: Support writing with appropriate, scholarly sources; provide relevant evidence of scholarly inquiry clearly stating how the evidence informed or changed professional or academic decisions; evaluate literature resources to develop a comprehensive analysis or synthesis; use sources published within the last 5 years; match reference list and in-text citations match, and minimize or appropriately format direct quotations.
|
| Interactive Dialogue | 40 | 27% | The quality for this category is determined by substantive written responses to a peer and faculty member’s questions in the threaded discussion. Substantive posts add importance, depth, and meaningfulness to the discussion. Students must respond to least one peer in the threaded discussion. If no question asked directly from faculty, student must respond to questions posed to the entire class. Post must include at least one scholarly source.
|
| Total CONTENT Points= 130 | |||
| DISCUSSION FORMAT | |||
| Category | Points | % | Description |
| Grammar, Spelling, Syntax, Mechanics and APA Format | 20 | 13%
|
Reflection post has minimal grammar, spelling, syntax, punctuation and APA* errors. Direct quotes (if used) is limited to 1 short statement** which adds substantively to the post.
* APA style references and in text citations are required; however, there are no deductions for errors in indentation or spacing of references. All elements of the reference otherwise must be included. **Direct quote should not to exceed 15 words & must add substantively to the discussion |
| Total FORMAT Points= 20 | |||
| DISCUSSION TOTAL=150 Points | |||
What Students Are Saying About Us
.......... Customer ID: 12*** | Rating: ⭐⭐⭐⭐⭐"Honestly, I was afraid to send my paper to you, but you proved you are a trustworthy service. My essay was done in less than a day, and I received a brilliant piece. I didn’t even believe it was my essay at first 🙂 Great job, thank you!"
.......... Customer ID: 11***| Rating: ⭐⭐⭐⭐⭐
"This company is the best there is. They saved me so many times, I cannot even keep count. Now I recommend it to all my friends, and none of them have complained about it. The writers here are excellent."
"Order a custom Paper on Similar Assignment at essayfount.com! No Plagiarism! Enjoy 20% Discount!"
