Expert Clinical Rules Automate Steps in Delivering Evidence-based Care in the Electronic Health Record

Abstract

A working framework is presented for interdisciplinary professionals for designing, building, and evaluating clinical decision support rules (expert rules) within the electronic health record. The working framework outlines the key workflow processes for eight health system organizations for selecting, designing, building, activating, and evaluating rules. In preparation, an interdisciplinary team selected expert rules for their organizations. A physician, a nurse, and/or pharmacy informatics specialists led the team for each organization. The team chose from a catalog of expert rules that were supported by regulatory or clinical evidence. The design process ensured that each expert rule followed evidence-based guidelines and was programmed to automate steps in planning and delivering patient care. Expert rules were prioritized when improving the safety and quality of care. Finally, clinical decision support rules were evaluated for abilities to improve the consistency and currency of assessments and follow-through on patient findings from these assessments. The informatics specialists from each of the health system organizations also participated in a health system oversight group to construct the key processes for this beginning framework. The group refined the processes for the selection, design, construction, activation, and evaluation of expert rules over the past 3 years. These steps offered direction to subsequent clinic and hospital organizations in a similar situation. This case study identified four key considerations when implementing and evaluating the clinical decision support expert rules within care delivery. In summary, the processes for decision support expert rules required rigorous development and change control processes to support operation.

Integrating Change Management into Clinical Health Information Technology Project Practice

“…Like IBM, in an attempt to reduce stress and resistance and increase system adoption rates, the literature reveals that soft CM is a necessary and effective strategy worthy of integration with PM. The call for CM in clinical HIT comes from applications such as telemedicine, CPOE, EHRs, EMRs, and Decision Support Systems [16,17,18,19,20,21].…”

Evaluating Clinical Decision Support Rules as an Intervention in Clinician Workflows With Technology

“…All clinical services were supported by CDSRs to achieve one or more goals previously identified in guiding principles for CDS. 7 Clinical decision support rules required cited standards, published research, and evidence-based practices to guide the decision on how data were used for the build of logic into Discern Expert application, but we found 35% of the CDSRs without supporting information.…”

“…7 The formulation of a new conceptual model, new education modules, and a CDS data use model is discussed here. These evolving new tools provided validating steps to use preexisting and new CDSRs.…”

Interdisciplinary Plans of Care, Electronic Medical Record Systems, and Inpatient Mortality

“…IPOCs are principally structured notes for goals and records of progress that guide patient care. [12][13][14][15][16][17] In addition, they combine evidence-based goals with multiple EMR typologies, like documentation structure and observations to inform electronic orders.…”