CDS Exhibit 1 Sample Table with Banded Rows Data Display Data Retrieval Workflow Data Entry Decision Making Data always available Single sign on (for In-basket Context-sensitive Invokes supply of multiple applications) templates guide knowledge - Flow sheets (e.g., Reminders in documentation access to problem list, Overcomes interface support of medication list) vs. integration timeliness, Immediate access to on a topic (through one system compliance active decision Maintain or repository) issues support Drug and other longitudinally Schedule/patient list rule-based alerts Across continuum Ease of navigation aids Patient status Improve adoption productivity Reminders continuously Dynamic displays Density of screen Workgroup tools Timely care Clinical guidelines Flow sheet/graphic/ and pathways “Flip-ability” Can be intrusive table/narrative - Easy handoffs Chronic disease helps review data Avoids getting lost in Structured data Refills management drill downs timely/accurate Clinical imaging Contributes to Patient/family integration Specialized formats downstream Referrals timely focuses information knowledge preferences Search tools Integrated Diagnostic Customized screens Issues Query support clinical/financial decision support Standards vs. Screen size Summaries/abstracts Overcomes Use of personal preference inability to pay for Device weight, Quickens access, epidemiologic data treatment heat, placement supports continuity Real-time of care Telephony, email, Intuitive support surveillance instant messaging Quick response CDS Active forms of CDS must be appropriately engineered to find the balance between annoying clinicians and enhancing patient care and safety, and improving measurement. Many EHR users advise turning off all CDS, then slowly add what you need. Instead, be judicious about active alerts, monitor utilization including monitoring overrides and complaints, and improve the quality of CDS by appropriately leveling the sensitivity of active alerts. Some complaints commonly heard about active alerts include: May be too general, textbook-like May not be actionable. Contains too much information that is distracting and time consuming, interfering with clinical judgment Does not blend into care processes Considered to contribute to extra and unnecessary work Complicated to use Multi-layered, time-consuming input and query functions Problems with inconsistent architectures, insufficient bandwidth, non-standard deficient data, incompatible workflows, and not intuitive Incompletely implemented, often in response to resistance
CDS Exhibit 1 Sample Table with Banded Rows Data Display Data Retrieval Workflow Data Entry Decision Making Data always available Flow sheets (e.g., problem list, medication list) Maintain longitudinally Across continuum Dynamic displays Flow sheet/graphic/ table/narrative - helps review data Clinical imaging integration Search tools Query support Summaries/abstracts Quickens access, supports continuity of care Single sign on (for multiple applications) Overcomes interface vs. integration (through one system or repository) issues Ease of navigation aids adoption Density of screen “Flip-ability” Avoids getting lost in drill downs Specialized formats focuses information Customized screens Standards vs. personal preference In-basket Reminders in support of timeliness, compliance Schedule/patient list Patient status continuously Workgroup tools Easy handoffs Refills timely/accurate Referrals timely Integrated clinical/financial Overcomes inability to pay for treatment Telephony, email, instant messaging Quick response Context-sensitive templates guide documentation Immediate access to active decision support Improve productivity Timely care Can be intrusive Structured data Contributes to downstream knowledge Issues Screen size Device weight, heat, placement Intuitive support Invokes supply of knowledge - access to on a topic Drug and other rule-based alerts Reminders Clinical guidelines and pathways Chronic disease management Patient/family preferences Diagnostic decision support Use of epidemiologic data Real-time surveillance CDS Active forms of CDS must be appropriately engineered to find the balance between annoying clinicians and enhancing patient care and safety, and improving measurement. Many EHR users advise turning off all CDS, then slowly add what you need. Instead, be judicious about active alerts, monitor utilization including monitoring overrides and complaints, and improve the quality of CDS by appropriately leveling the sensitivity of active alerts. Some complaints commonly heard about active alerts include: May be too general, textbook-like May not be actionable. Contains too much information that is distracting and time consuming, interfering with clinical judgment Does not blend into care processes Considered to contribute to extra and unnecessary work Complicated to use Multi-layered, time-consuming input and query functions Problems with inconsistent architectures, insufficient bandwidth, non-standard deficient data, incompatible workflows, and not intuitive Incompletely implemented, often in response to resistance
strategies_for_optimizing_an_ehr_system_0_0.docx