Evidence-based safety, quality, and decision-making support tools embedded in information

Decision-Making Support Tools

These tools provide the right information to the right person at the right time, enhancing clinical reasoning and leading to more informed decisions.

Evidence-based Order Sets: Instead of manually selecting individual lab tests and medications for a specific diagnosis, a provider can choose a pre-configured, evidence-based order set. This streamlines the process and ensures that all necessary, evidence-based actions are taken for a given condition (e.g., a "sepsis workup" order set).

Context-Specific Recommendations: These tools go beyond simple alerts by providing a direct recommendation based on patient-specific data. For example, a system might analyze a patient's blood pressure, weight, and history to recommend a specific dosage of an antihypertensive medication.

Embedded Clinical Information: Many systems provide links to or embed content from respected medical knowledge bases (e.g., UpToDate, PubMed) directly within the patient chart. This allows a provider to quickly access the latest research and guidelines without having to leave their current workflow, facilitating informed decision-making at the point of care.

Sample Answer

Evidence-based safety, quality, and decision-making support tools are integrated features within healthcare information systems that use current clinical research and best practices to assist providers in delivering optimal care. These tools are embedded directly into the workflow, providing real-time, patient-specific guidance to prevent errors, improve outcomes, and enhance clinical judgment.

Safety Tools

These tools are designed to prevent harm to patients by flagging potential risks before they occur. They act as automated checks and balances within the system.

Medication Safety Alerts: When a provider orders a new medication, the system automatically checks for potential drug-drug interactions, drug-allergy interactions, or a medication dose outside of the standard range. For example, if a patient is allergic to penicillin and a provider orders amoxicillin, a pop-up alert will immediately warn of the allergy before the order can be completed.

Clinical Contraindication Alerts: The system uses patient data (e.g., laboratory results, vital signs, pre-existing conditions) to alert providers to potential contraindications. For instance, an alert might prevent a provider from ordering a specific contrast agent for a patient with renal failure.

Patient Risk Assessment Tools: Integrated tools, such as the Morse Fall Scale or Braden Scale for pressure ulcers, prompt clinicians to perform a structured risk assessment and then automatically generate a care plan with specific interventions based on the score.

Quality Tools

Quality tools ensure that care is consistent, comprehensive, and aligned with the latest clinical guidelines. They help close gaps in care and ensure adherence to best practices.

Clinical Pathway and Protocol Checklists: For common conditions like pneumonia or sepsis, the information system presents a standardized order set or a checklist based on evidence-based protocols. This guides the provider through all necessary steps, from initial diagnostic tests and medication orders to discharge planning, ensuring continuity and consistency of care.

Preventative Care Reminders: The system uses patient demographics and health history to automatically prompt providers to schedule overdue preventative services. For example, if a 50-year-old patient hasn't had a colonoscopy, an alert will appear on their chart. This helps to ensure that no care is forgotten.

Population Health Dashboards: These tools aggregate data across a patient population to measure overall quality metrics. A dashboard might show the percentage of a clinic's diabetic patients with A1c levels below a certain threshold or the influenza vaccination rate for the entire hospital. This allows administrators and clinicians to identify systemic issues and implement targeted improvements.