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Author: Elyse, PMP, CPHIMS
September 23, 2009

As one changes from a paper based practice to an electronic based practice, there are a lot of changes in workflow. One change to constantly remain cognizant of is the placement of alerts, reference information, and order sets to help support clinical decisions. When implementing a system, this is one of the key things to collaborate upon and make sure it tested by acceptance not by fire. Additionally with alerts and rules, these are to be grown over time. Having 300 rule alerts in place at go-live is way too painful, and will negatively affect the usage of the system. The trick of the trade is getting collaboration on the first 5 rule alerts and setting up a process to vet and implement the remaining 295.

Fortunately for those of us new to the field, there is the CDS 5 Rights Model. The CDS Five Rights model states that we can achieve CDS-supported improvements in desired healthcare outcomes if we communicate:
  1. The right information: evidence-based, suitable to guide action, pertinent to the circumstance
  2. To the right person: considering all members of the care team, including clinicians, patients, and their caretakers
  3. In the right CDS intervention format: such as an alert, order set, or reference information to answer a clinical question
  4. Through the right channel: for example, a clinical information system (CIS) such as an electronic medical record (EMR), personal health record (PHR), or a more general channel such as the Internet or a mobile device
  5. At the right time in workflow: for example, at time of decision/action/need

So let's take a high level view of this item and for your implementation. Successful usage of rules needs to have adoption from the organization. There is the main risk factor. As organizations become more sophisticated processes are developed and technologies are utilized to achieve the desired outcomes. However, achieving every outcome all at once instantly doesn't normally hold true. So the key is to be able to have a collaborative process to develop the order sets, review the protocols, and implement a process to grown the pool of alerts to provide feedback when it is resonates. There are good tools to get you good started like zynx health for evidenced based clinical decision support. In moving forward plan in time to agree to the order sets and process for adding new alerts, test the functionality within the system, train upon the order sets, and then even market and get adoption. I've seen organizations start very early in the process transition to the evidenced based orders maybe even within the current paper process.

Further Readings on the Getting Ready for Meaningful Use Series:

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1 Comments to “Getting Ready for the Meaningful Use EHR - Using Rules to support clinical decisions”

I agree that it is way too overwhelming for most physicians implementing an EMR system to even fathom the ability to navigate 300 rule alerts. Your 5 Rights Model presents the info in a concise format that is more "user-friendly." Nice post!

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