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Focusing on the Patient: Keeping Peripheral Vision on Organization.

CPR's help clinicians focus on patient needs while maintaining the vision of the organization.

In today's busy healthcare environment, the clinician directly responsible for the patient has got to stay focused on the care of that patient. What better way to help the clinician focus than to use technology to interactively update patient care information. And, what better way to use technology to simultaneously prompt clinicians to adhere to their healthcare organizations (HCO) standards while caring for the patient.

The computer-based patient record (CPR) is one of numerous tools being used to support the clinician in patient care decision-making. Indeed, online clinical decision support protocols within CPRs are revolutionizing the way healthcare providers deliver care and measure results. With real-time alerts, warnings, reminders and guidelines embedded in the system, healthcare providers can greatly enhance the quality of their clinical decision--and the competitiveness of their organization. With the CPR, the clinician can focus on exact patient needs while maintaining the vision of the healthcare organization.

Rules for clinical alerts and workflow processing, or Interactive Decision Agents[TM], can be used in a variety of actions with the CPR--during the physician order-entry process, as automatic by-products of documentation by any discipline, in any venue, across the entire continuum of care. Most importantly, these actions can highlight all exceptions to the norm with visual cues and/or audible pages to ensure effectiveness.

In essence, these Interactive Decision Agents work to assure the clinician can focus on all of the details of the patient interaction while adhering to the standards of the HCO. And, the difference for the patient can be seen in a variety of significant healthcare and health maintenance processes. Here are 10 examples that can help all healthcare professionals to stay focused.

* Health maintenance reminders: In today's health-conscious culture, we can no longer care only for the sick. Providers must be proactive in helping to manage the health and wellness of their patients. Automatic health maintenance reminders of flu shot boosters, annual physicals or hemocult tests, can prompt clinicians to record, track and screen patients.

* Matching criteria to enhance care, control costs: Demand Management is necessary to control healthcare costs by matching the need for services and the selection of the appropriate healthcare treatment. Provider and treatment recommendations are based on multiple decision criteria to ensure compatibility with the patient's insurance coverage, service availability/schedules, patient preferences and provider matching by location.

* Ensuring JCAHO compliance: The Joint Commission on the Accreditation of Healthcare Organizations (JCAHO) expects certain standards to be met to stay within compliance guidelines. These rules are simple for the CPR's rules-engine to monitor and maintain. For example, all acute-care admissions must have a nursing assessment documented within 24 hours of the patient's arrival. The system can send the nursing supervisor a message to highlight the names of all patients who have not met these criteria so that action can be immediately taken to assure that patients have this vital assessment documented in the record.

* Proactive monitoring of patients: The CPR can help clinicians in deciding which patients may meet further evaluation criteria. The system can automatically flag patients who belong to a specific disease category that requires high utilization (e.g., repeat visits, excessive emergency department or clinic visits) or high-cost drug therapy programs that do not comply with the therapeutic treatment recommendations.

* Exception-based patient data review: The CPRs clinical desktop can furnish each healthcare professional with specific visual cues to highlight changes in his/her patient population. For example, lab results can be highlighted in yellow if abnormal and red if critical. If desired, certain thresholds of critical data can automatically send a signal to the appropriate clinician's pager.

* Prompts to further action: Using an integrated, patient-centric CPR, a healthcare provider's assessment of a patient or action can trigger other suggested interventions, procedures or events for the future. For example, if a patient updates his or her SF- 36 form during a visit to a specialist, the system can automatically route this information to the primary care provider for the next check-up and alert that provider with a real-time notification, if the change is significant.

* Automatic case assignment: CPRs should provide decisions on which cases need review or human intervention based on any high cost, high acuity or high resource consumption conditions. For example, in the long-term care environment, if the patient's assessment states he or she has vision and hearing impairments and is over 65, the standard "at risk for falls" protocol can be evoked.

* Automatic orders for scheduled procedures: Scheduling any treatment or procedure should not require extra time from the physician if the protocols are standard. Automatically associated orders ensure that the procedure can occur at the time it is scheduled, ultimately saving the healthcare organization from rescheduling or increasing the patient's length of stay simply due to an improper patient preparation.

* A unique patient-focused worldview: Each clinical team member can create a template of specific items that he or she wants to review each time he or she signs onto the system. For example, it is important for the clinical pharmacist to ensure that patients on certain antibiotics do not become nephrotoxic (have kidney problems). Therefore, creatinine results are vital for the pharmacist to automatically review for specific drugs, such as Vancomycin.

* Retrospective analysis: Obviously, not all clinically significant findings are seen online in real-time. Therefore, clinical practitioners are provided with data on populations of patients to study outcomes and achieve the best clinical practices. For example, in studying the diabetic population of patients for disease management, one can review patients placed on a diabetic pathway versus non-pathway patients to compare glycosylated hemoglobin results.

Clinical decision support systems touch many vital concerns of all healthcare professionals. Moreover, the Interactive Decision Agents embedded in these systems are changing the way healthcare providers look at patient care and the HCO. After all, we want to do more than simply "see" patients at the point of care--we want to focus on the patient while keeping our peripheral vision attentive to the healthcare organization we serve.

Roberta A. Rochman, RN, MBA is Director of Healthcare Solutions at Per-Se Technologies, Inc., based in Atlanta.
COPYRIGHT 1999 Nelson Publishing
No portion of this article can be reproduced without the express written permission from the copyright holder.
Copyright 1999 Gale, Cengage Learning. All rights reserved.

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Author:Rochman, Roberta A.
Publication:Health Management Technology
Date:May 1, 1999
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