In 2015, McKesson released its newest EHR clinical decision support system called InterQual 2015. The updated system contains 55 new evidence based clinical content areas, and contains 33 new molecular diagnostic tests and criteria for 29 new specialty drugs. InterQual 2015 is comprised of 5 content suites, they are:
Level of Care Criteria: Decision support based off of intensity of services, severity of illness and comorbities. Behavioral Health Criteria: Decision support to aid clinicians in managing mental health and substance abuse patients both at the initial and existing stages.
Care Planning Criteria: Decision support to help providers understand when imaging, procedures, specialty referrals, medications etc. are appropriate.
In conclusion, clinical decision support systems provide a mechanism for improving the quality of care services when integrated with evidence-based practice and clinical guidelines. These systems would particularly improve health care quality when combined with evidence-based medicine. This process may also include the use of databases and condition-specific clinical guidelines to improve their effectiveness and efficiency.
Fortinash, K. M., & Holoday Worret, P. A. (Eds.). (2012). Substance-related disorders and addictive behaviors. Psychiatric mental health nursing (5th ed., pp. 319-362). St. Louis, MO: Elsevier Mosby.
Healthcare providers must make their treatment decisions based on many determining factors, one of which is insurance reimbursement. Providers always consider whether or not the organization will be paid by the patients and/or insurance companies when providing care. Another important factor which affects the healthcare provider’s ability to provide the appropriate care is whether or not the patient has been truthful, if they have had access to health, and are willing to take the necessary steps to maintain their health.
Priority Setting is where problems are grouped as having high, medium, and low priority based on preferential sequencing for the order in which diagnoses and interventions need to be addressed.
4.Decision support:eClinicalWorks has partnered with Zynx Health to fully integrate library of order sets into their EHRs, this order sets are preferred treatment plans for a given diagnosis that providers can use to treat patient.The company also offers eClinicalSense considered as artificial intelligence system which helps provider store and retrieve past given treatment plan for a specific
The implementation of the Clinical Decision Support System (CDSS) was to allow physicians the ability diagnoses patients with the use of evidence based decisions. Physicians can explore relevant medical information through the CDSS from reliable medical experts, clinical guideline extractions and alerts of new and different phases of patient management without the interruption of the medical organization’s workflow (Chiarugi, Colantonio, Emmanouili...
The patients should receive safe and appropriate care in return for payment equal to the level of care received (“What is Value-Based Care”, 2016). For providers, this means using affordable and proven treatments while also catering to the patient’s needs (“What is Value-Based Care”, 2016). Additionally, this model is built upon measurement which when relayed to the patient will inform them of the scope and cost of their care. Examples of measures that are tracked, provided by the article “What is Value-Based Care,” include: procedural complications, hospital-acquired infections, and readmissions; providers face penalties if these metrics are unacceptable (“What is Value-Based Care”,
Electronic Health Record (EHR) is a digital collection of patient health information instead of paper chart that captures data at the point of collection, supports clinical decision-making and integrates data from multiple sources in any care delivery settings. The health record includes patient’s demographics, progress notes, past medical history, vital signs, medications, immunizations, laboratory data and radiology reports. National Alliance for the Health Information Technology defines EHR as, “ an electronic record of health-related information on an individual that conforms to nationally recognized interoperability standards and that can be created, managed, and consulted by authorized clinicians and staff across more
A major component of clinical decision support system is it helps locate and prevent errors made by many providers. Other components of a clinical decision- support system are speed- this can make or break at system, it is very annoying if you have to set and wait for the system to perform a simple function as looking up information, the need and delivery of real time- if there is lag time and the information needed doesn’t appear in seconds it can pose as the system is not performing up to par, fit of the users work –flow- the alerts, guidelines, and algorithms need to be in place so there are no confusions when a users are dispersing medications, usability- this makes a tremendous difference in how a system performs many clinician want to be able to use a computer system with ease, if the system is to complicated it can appear as not user friendly, being aware that there will be resistances from the provider- offend many providers will give pushback on changing there mind without input as to way a change is required; for example should x-rays be taking on all patients with abdomen pain, approximately five percent of physician actually went with the recommendation of not ordering x-rays on patie...
Quality patient care is an ongoing endeavor that involves many different areas of healthcare. One area of healthcare that is often employed is Utilization Management. We read in John’s that UM “is composed of a set of processes used to determine the appropriateness of medical services provided during specific episodes of care” (John,2011). Things that are used to determine the appropriateness of care include the patient’s diagnosis, site of care, length of stay, and other clinical factors. This system consists of three main functions aimed at improving patient care and controlling healthcare costs. These functions include utilization review, case management, and discharge planning. One source states that it also includes the claim denials and appeals process (Interviewee C. Jarvis, e-mail communication, May 3, 2014). When used correctly, these UM processes can expedite the patient’s care and reimbursement. It also demonstrates to third party payers that the organization is taking measures to help control costs. This monitoring and management of patient healthcare needs ensur...
Referral should also be considered if the patient's condition does not improve in the expected time or if there is any deterioration
“Common Reasons Why Those Who Need Treatment Don’t Get It”. Elements Behavioral Health. Web. May 21, 2014.
In practice, there are other assessment tools such as….which I could have used but the CPA is a recommended National Standard Framework for Mental Health, introduced in 1991, to supply a framework for effective mental health care (DOH 1999; DOH 2008) and to safeguard all service users (SU) by appropriate assessment and review (Gamble, 2005). But it is time consuming, in practice and paperwork. Service users’ participation has been repeatedly disappointing; studies constantly report little awareness of the CPA policy (CPAA, 2006; McDermott, 1998).
Substance abuse complicates almost every aspect of care for the person with a mental disorder. When drugs enter the brain, they can interrupt the work and actually change how the brain performs its jobs; these changes are what lead to compulsive drug use. Drug abuse plays a major role when concerning mental health. It is very difficult for these individuals to engage in treatment. Diagnosis for a treatment is difficult because it takes time to disengage the interacting effects of substance abuse and the mental illness. It may also be difficult for substance abusers to be accommodated at home and it may not be tolerated in the community of residents of rehabilitation programs. The author states, that they end up losing their support systems and suffer frequent relapses and hospitalizations (Agnes B. Hatfield, 1993).
The key area of decision-making on direct patient care is intervention effectiveness, picking an intervention