Tuesday, September 22, 2009

Guidelines and Protocols

I'm often asked about decision support capabilities in the BIDMC inpatient and outpatient EHR. I've previously written about our general principles of decision support and our priorities for implementing electronic guidelines and protocols.

I thought it would be interesting to show you the screens from our self-built Provider Entry System. I've included the protocol for Complex antibiotic ordering per protocol, our protocol for Heparin Dependent Antibodies, our Hydration Protocol to minimize risk of Iodinated Contrast Neprhropathy, Red Cell ordering, and TPN ordering.

I've also included an overview of our web-based ambulatory EHR, called webOMR. You'll see all the meaningful use features - vocabulary controlled problem lists, medication management (including medication reconciliation, e-prescribing, drug/drug interaction checking), clinical documentation, screening sheets which display all results and quality measures specific to treatment of a disease process, and ordering with complete decision support to ensure labs and radiology orders follow best practice guidelines.

The thematic definition of meaningful use is:

2011: To electronically capture in coded format, and to report health information, and to use that information to track key clinical conditions

2013: To guide and support care processes and care coordination

2015: To achieve and improve performance and support care processes and on key health system outcomes

Our inpatient and ambulatory systems are evolving constantly to meet these goals.


Lindsey Hoggle said...

Thank you for translating "meaningful use' into simple concepts so many will understand the definition will continue to evolve. Thanks also for sharing screen shots. I am intrigued by TPN Order Set--are there additional support parameters? Criteria bassed upon nutritional status? Appreciate your willingness to share.

Brian Ahier said...

Thanks for the excellent thematic definition! That is the most concise summary I have seen yet...

To get a little more specific I would add some additional criteria:

* Use CPOE for all order types including medications;
* Implement drug-drug, drug-allergy and drug-formulary checks;
* Maintain an up-to-date problem list;
* Generate and transmit permissible prescriptions electronically;
* Maintain an active medication allergy list;
* Send reminders to patients per their preference for preventive and follow-up care;
* Document a progress note for each encounter;
* Provide patients with an electronic copy or electronic access to clinical information such as lab results, problem list, medication lists and allergies;
* Provide clinical summaries for patients for each encounter;
* Exchange key clinical information among providers of care;
* Perform medication reconciliation at relevant encounters;
* Submit electronic data to immunization registries where required and accepted;
* Provide electronic submissions of reportable lab results to public health agencies;
* Provide electronic surveillance data to public health agencies according to applicable law and practice; and
* Comply with federal and state privacy/security laws and the fair data sharing practices in HHS' Nationwide Privacy and Security Framework

How To Make A Solar Panel said...

seriously this is a great job done. In a clearly understandable format. Looks like the diagnosis become more easier. And for improvement, it is better to have the risk areas (high, intermediate and usual)in "Hydration Protocol to Minimize the Risk of Iodinated Contrasts Nephropathy" , in more specific way, in order to clearly identify.