7 - HIT Patient Safety Flashcards
Functions of the EHR
Scheduling / Billing / Documentation
Fascilitation of
Communication between Providers & Patients
Improve clinical
DECISION MAKING & CARE process
accessible information
More Effective = System Orientated
less effective = Human Oreintated
Varying Degrees of Automation
with CDS
Clinical Decision Support
Examples of:
Clinical Decision Support=CDS
Provides
Timely information @ point of care
to
inform decision about patient’s care
Types of CDS Interventions:
Electronic Order Entry Forms
Display of information relevant to order / decision
Nudge - guide decision behaviors
CONSTRAINTS list of choices = FORCE FUNCTION
Alerts & reminders
Data Summaries / Predictive Analytics
Ex. Types of CDS interventions:
Electronic Order Entry Forms
LIMITATIONS / WORKAROUNDS
if the fields are NOT required –> often left blank
1st choice is OFTEN MOST COMMONLY USED
Ex. Types of CDS interventions:
Display of Relevant Information
- Display heart rate trend when ordering beta-blocker
- Show renal function when ordering aminoglycoside
- *Limitations & Workarounds:**
- *have to link the CORRECT information = difficult**
single data points –> TREND IS MISSED
Ex. Types of CDS interventions:
Guiding Decision Behaviors
ex.
Opioid Prescribing –> reduce QTY prescribed
Limitations / Workarounds:
Prescribers NOT required to choose PRE-BUILT order
Can falsely assume DEFAULTS
Resource intensive to keep guidelines
Ex. Types of CDS interventions:
Constrain Choices
Ex.
- *Promethazine –> route of ADMIN**
- *Opioid –> only for MODERATE - SEVERE pain INDICATION**
Limitations / workarounds:
Nurse can still IV administer drug
Opioid can still be prescribed under something else
Ex. Types of CDS interventions:
Order Sets
Ex.
Vitamin K sets // PCA linked orders
Limitations / workarounds:
Intensive maintaining / creating order sets
Constrain choices TOO MUCH
Risk Therapeutic duplication
Circumventing order sets
Ex. Types of CDS interventions:
Alerts & reminders
Ex.
Drug Interactions / PMP review
limitations / workarounds
ALERT FATIGUE
more alerts –> less useful they become
Alerts arent built to address EVERY potential error
Ex. Types of CDS interventions:
Predictive Analytics
Ex.
BG trends –> predict hypo/hyperglycemia
Monitoring parameters –> HR/Sleep trends
Social media monitoring –> prevent self-harm or suicide
Limitations / Workarounds:
Analytics only as good as the DATA/Algorythims they rely on
Low PPV –> compromise utility
Emerging Opportunities in
HIT & Patient Safety
Health Information Technology
Predictive Analytics
Device Equipment Interigation
Infusion pumps –> integrated into EHR
Order goes into compounder for IV products
WEARABLES
System Interoperability
PMP/EHR integration
