CDSS
Early systems of CDSS
Key CDSS Functions
- A software designed to be a direct aid to a clinical decision making, in which the characteristics of an individual patient are matched to a computerized clinical knowledge base & patient –specific assessments or recommendations are then presented to the clinician or patient for a decision (Sims et al.)
- Assist in problem solving
- Support, not replace, the judgment of a manager or clinicians
- Improve the effectiveness of the decision-making process
Early systems of CDSS
- 1972, CDSS that support Dx of acute abd’l pain developed by de Dombal @ Leeds University
- 1974,INTERNIST 1 developed @ University of Pittsburgh,supports diagnostic process in an internal medicine.
- Computer-aided Nursing Diagnosis & intervention (CANDI) – developed to assist nurses with care planning & nursing Dx.
Key CDSS Functions
- ADMINISTRATIVE- support for clinical coding & documentation
- Management of clinical complexity & details- keeping patients on research & chemotherapy protocols, tracking orders, referrals, follow-up, preventive care.
- Cost control- monitoring medication orders & avoiding duplicate or unnecessary tests.
- Decision support-supports clinical diagnostic & tx plan
ISSUES IN INFORMATICS
} Computerized Physician Order Entry & Electronic Medication Administration Record
Computerized Physician Order Entry (CPOE) is defined as the computer system that allows direct entry of medical orders by the person with the licensure and privileges to do so. Directly entering orders into a computer has the benefit of reducing errors by minimizing the ambiguity of hand-written orders, but a much greater benefit is seen with the combination of CPOE and clinical decision support tools (Ash, 2008)
Computerized Physician Order Entry (CPOE) is defined as the computer system that allows direct entry of medical orders by the person with the licensure and privileges to do so. Directly entering orders into a computer has the benefit of reducing errors by minimizing the ambiguity of hand-written orders, but a much greater benefit is seen with the combination of CPOE and clinical decision support tools (Ash, 2008)
} Bar Code-Enabled Point-of-Care technology
} Clinical assistant tablet
} Picture taking for documentation
} Barcode reading capability
} AUTOMATED DISPENSING CABINET
} work like medicine vending machine. They're designed to help make sure health care workers are giving patients the right medicine, and the correct dose.
} “SMART” INFUSION PUMP DELIVERY SYSTEMS
} With barcode system
} ROLE OF TECHNOLOGY IN THE MEDICATION-USE PROCESS
} 1999 INSTITUTE OF MEDICINE REPORT (IOM) report, To Err is Human: Building a safer Health System
} Between 44,000 & 98,000 patients die each year in the US from preventable medical error.
} Computerized Prescriber Order Entry (CPOE)
} Bar Code-Enabled Point-of-care Technology
} Automated Dispensing Cabinets
} Smart Infusion Pump delivery System
} PRACTICE APPLICATION
} Nursing documentation
} 1986, ANA House of Delegates passed a resolution to promote the development of computerized nursing information systems (NIS)
} 1993, another resolution to “develop nursing classifications specifically aimed @ dx, intervention, patient outcomes ,&support activities directed toward the inclusion of nursing data elements in healthcare databases
} Recognized Terminologies that support Nursing practice
} NANDA- nursing dx , definitions, & classification
} NIC- nursing interventions classifications system
} HHCC- home health
} OMAHA system
} NOC- nursing outcomes classification
} NMMDS- nursing management minimum data set
} PCDS- patient care data set
} PNDS- perioperative data set
} SNOMED
} NMDS- nursing minimum data set
} ICNP- international classification of nursing practice
} ABC codes
} LOINC- logical observation identifiers names codes
} Care planning
} Computer based patient record facilitates automation of the nursing care planning
} Enables nurses to quickly move to synthesis of nursing knowledge
} Managers are able to query clinical records with questions about the provision & result of care.
} System is useful to process improvement, performance evaluation & strategic planning
} Decision-Making with Administrative Data
} Without day-to-day information on patient flow & acuity , resources use, staffing levels, cost & budgetary balance , leaders/managers have little support for cost control & input into budgetary decision making.
} Decision-Making with Expert Systems
} AI – expert systems & machine learning – have been used to aid decision-making in nursing.
} Uses knowledge & procedures to infer new information from what is already known about a problem
} Enhances understanding, reasoning, & decision making
} Outcomes Management
} Provides a powerful illustration of how nurses use informatics in daily practice to evaluate the relationship between patient goal attainment & nursing intervention
} Outcomes can include factors such as increased client satisfaction, decreased hospital admissions, & ER visit, decreased cost& acuity of hosp stay, decreased morbidity/ mortality, minimized hospital revenue loss, increased job satisfaction for nurses, & decreased job stress
} Discharge planning
} Provide for continuity of care from the home to the hospital back to the community, another care facility, outpatient department or the home.
} Can involve social workers, physician, dietician, occupational therapist, pharmacist & physical therapist.
} Closely coordinated communication among healthcare provider s can result to up-to-date discharge planning
} Critical Care Application
} Critical care nursing
} A nursing specialty that deals with human responses to life- threatening problems
} A critically ill patient requires intensive assessment & interventions.
} Info tech in critical care environment major capabilities
} Process, store, & integrate physiologic & diagnostic information
} Preset deviation from preset ranges by an alarm
} Evaluate patients for outcome analysis
} Provide access to vital patient information from any location
} Device Connectivity Infrastructure
} Bedside monitoring devices are capable of sending information to software applications.
} Medical Information Bus(MIB)-infrastructure used to send the workload generated by the patient care devices
} Most Medical devices have communication ports available that have the capability to transmit data from to clinical software application
} Physiologic monitoring system
} 1960,NASA developed physiologic monitors to oversee VS of astronauts
} 1970,found their way into the hospital setting
} Microprocessor analyzes information, stores data in specific places,& controls the direction of reporting(e.g., paper report, graphic files, shift summary report)
} Controlling component alerts nursing personnel through report, alarm, or visual notice.(e.g. notice on display screen;”increase pt. O2 or check for leaks”)
} Hemodynamic Monitors
} Measures hemodynamic parameters
} Closely examine cardiovascular function
} Evaluate cardiac pump output & volume status
} Recognizes patterns (arrhythmia analysis)
} Assess vascular system integrity
} Evaluate pts physiologic response to stimuli
} Continuously assess respiratory gases
} Evaluate blood gases & Electrolytes
} Estimate cellular oxygenation
} Evaluate glucose level
} Store waveforms
} Automatically transmit selected data to a computerized patient database
} COMMUNITY HEALTH APPLICATION
} Public Health
} A coordinated effort at the local, state, & federal levels whose mission is fulfilling society’s interest in assuring conditions in which people can be healthy(IOM,2004)
} Public professionals focus on:
1. Preventing identifying, investigating, & eliminating community health problem
2. Assuring that the community has access to competent personal health care services
3. Educating & empowering individuals to adopt more healthy behaviors (NIH,1996)
} Community health Systems
} Connotes those computerized IT systems specifically developed & designed for use by community health agencies, local & state health departments, community programs, & services.
} Systems used in Community Health
} Categorical Systems
} Screening programs
} Client registration system
} MIS
} Statistical reporting systems
} Special purpose systems
} Categorical program systems
} Designed to support data processing& tracking specific programs such as cancer detection, MCH immunization, or family planning
} Generally count, track, & identify the health status of registered clients
} Screening programs
} Used to detect individuals afflicted with specific disease or predisposing health condition
} Registration system
} Designed to identify state/local residents/clients eligible for CHN services in clinics & home.
} Consist of online communication network linked to a central computer facility used to collect, store, & process data.
} Management information system
} Provides framework for collecting & reporting statistical as well as financial data needed for the management of operational needs of agency &professionals.
} Statistical reporting systems
} Developed to collect & process statistical information primarily for state/local health departments such as epidimiologic & immunization data.
} Special purpose system
} Developed to collect statistical data for administering a specific program (rather than the agency)
} Provides statistics needed to obtain funds for categorical programs or block grants.
} E.g. programs for children with medical handicaps,drug abuse etc.
} Ambulatory Care Systems
} A response to increasing costs of providing healthcare
} Health industry has moved away from expensive inpatient, acute care environment to caring for clients in various ambulatory care settings
} Where ambulatory clients are being treated?
} Ambulatory clinics
} Surgery centers
} Single & & multi specialty group practices
} Diagnostics laboratories
} Health maintenance organizatios
} Independent physicians organization
} Birthing centers
} Community health centers
} RHU
} Pain management clinics
} Dialysis centers
} Nurse managed centers etc..
} INTERNET TOOLS FOR ADVANCED NURSING PRACTICE
} Basic & advanced Internet search methods
} Use search string (if insulin dosing is needed, then enter “insulin dosing” not “insulin”
} Enhance search string by Boolean or natural language method ( AND, OR, or NOT)
} Maybe used as follows;
asthma AND (death OR mortality) AND rates AND children AND 2002
- leads directly to the same hyperlink
-clinicians must understand differences among domains& evaluate the credibility of the content
} Internet- Available Clinical Practice Tools
} Assessment
} Refers to systematic collection of data needed to arrive at one or more dx
} First step in the nursing process
} BMI calculator ( http://nhlbisupport.com/bmi/bmicalc.htm )
} Cancer risk tools: maybe calculated for breast, prostate, lung, colon, bladder, melanoma, uterine, kidney, pancreatic, ovarian, stomach &cervical cancer( http://hin.nhlbi.nih.gov/atpiii/calculator.asp?usertype=prof )
} Health risk calculators from University of Maryland for 24 health conditions ( http://www.umm.edu/healthcalculators/ )
} Diagnosis
} Medical classification of diseases e.g. International Classification of Diseases (ICD)
} Nursing classification of human responses to illness & health e.g. NANDA classification of nursing dx
} Functional health & disability, e.g. International Classification in Health & Disability
} Nursing treatment
} Home Health Care Classification (www.sabacare.com)
} Nursing Intervention Classification(NIC) http://www.nursing.uiowa.edu/centers/cncce/nic/index.htm
} Omaha system (http://www.omahasytem.org/)
} Perioperative nursing data set ( http://www.aorn.org/research/pnds.htm)
}
} Calculators
} Drug admin purpose- http://www.manuelsweb.com/nrs_calculators.htm
} Outcomes
} Nursing Outcomes Classification, a standardized nursing terminologies can be obtained @ (http://www.nursing.uiowa.edu./centers/cncce )
} Outcomes measurement biostatistical & analytical tools
} Chi-square calculator
} Qualitative data creation,management , & analysis software
} Epidemiologic analysis software
} Students t-test calculator
} ADMINISTRATIVE APPLICATION
} Nurse manager
} Responsible for:
} Proper allocation of available resources
} Providing input into executive-level decisions
} Implementing philosophy, goals, & standardsof health care organization.
} Implement clinical nursing service within their defined areas of responsibilities
} Planning, organizing, implementing, & controlling, the care of individuals & aggregates including aspects of quality outcomes,staff development,care management,& research
} Nurse executive
} Responsible for managing organized nursing services & the environment in which clinical nursing is practiced
} Ensure standards
} Evaluate care delivery
} Foster a climate for practice that enhances productivity,job satisfaction,& professional development
} Nursing Information System
} A software system that automates the nursing process from assessment to evaluation, including evaluation
} Means to manage the data necessary for the delivery of patient care( e.g. patient classification, staffing, scheduling & cost)
} Nurse managers & executives must collect & analyze large amount of data. This become impossible without automated clinical & administrative nursing information system
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