Electronic Health Records and Clinical Decision Support

Abstract

The realization of effective and efficient processes in the health-care sector is a critical aspect of bolstering the delivery of high-standard services. Incorporating technological innovations into the field of health care is identified as a critical approach to facilitating positive results in the sector. The topic of electronic health records (EHR) and clinical decision support (CDS), which forms the basis of this paper, reveals some of the crucial strides made in the area of health care in terms of delivering desirable services to clients, thanks to the adoption of EHR and CDS systems. Such tools have helped to enhance information flow along with knowledge management and, consequently, the quality of care.

Introduction

This study offers a detailed examination of the topic of electronic health records (EHR) and clinical decision support (CDS). The topic has been selected based on an awareness of the extent to which the integration of EHS influences various means of health-care delivery. Specifically, EHS controls clinicians’ decisions after they have assessed clients’ medical history. In this light, use of EHR influences CDS by ensuring that clinicians apply evidence-based guidelines when deciding the channels to deploy in the process of health-care delivery. Notably, decision support systems (DSS) may obtain information from EHR to guide medical practitioners regarding the right course of action to take when attending to patients’ health needs.

In this respect, the discussion of EHR and CDS is significant since the automation of health records offers relevant information and channels that guide health-related decisions, facilitating the provision of quality services in the area of health care. Furthermore, the topic is also important because it uncovers the extent to which technological innovations affect the quality of the services delivered by providers. As revealed in this paper, various aspects of EHR and CDS systems such as knowledge management and information flow facilitate the flow and delivery of information in the health-care sector, thereby improving the quality of care offered to clients.

The Important Role of Information Flow in Health-care Delivery as Facilitated by EHR and CDS

Information Flow and Health-care Service Delivery

According to Simonian and Lam, a practical and efficient response to clinical needs requires health-care professionals to apply the appropriate information about patients’ health status.1 Notably, the availability of the right information is one of the five benefits of efficient CDS structures. In this respect, it is essential for clinicians to use evidence-based information to facilitate the delivery of services. EHR is a useful resource that enables access to appropriate information about the medical history of a particular client. Medlock et al. underline that streamlining the flow of information in decision support systems is critical not only for improving clients’ health but also for enhancing the overall delivery of health care.2 Over the years, clinical decision support systems have failed to realize their full potential in enhancing health-care delivery, owing to the absence of formalized information flow. As a result, Simonian and Lam emphasize the need to incorporate characteristics that foster the effectiveness of CDS systems in the health-care sector.1

Medlock et al. insist that obtaining patient data and information through observation and assessing medical history serve to streamline health-care delivery.2 In this regard, using EHR systems is recommended because they enhance the health officer’s course of reasoning. Specifically, integrating automatic recordkeeping processes influences the clinical stream and the cognitive behavioral stream.2 Therefore, including EHR in health-care delivery boosts the clinician’s level of judgment about a prevailing health issue. In other words, incorporating technologies such as EHR has been identified as enhancing the effectiveness of CDS during diagnostic processes. Undoubtedly, the use of EHR is linked to the correctness of clinicians’ conclusions after they have assessed a patient’s data and information. As such, the integration of EHR influences the effectiveness and efficiency of CDS, thereby bolstering the quality of health-care delivery.

According to Wright et al., factors such as the need for updated information and knowledge content are influencing the development of knowledge management in the health-care sector.3 In particular, the effectiveness of CDS and EHR systems is fostered by the quality of information obtained by establishing mechanisms that facilitate updating clinical rules, guidelines, and pathways. For this reason, knowledge management in health-care information systems requires unceasing adjustments and customization to ensure that clinicians and patients are satisfied with the services aided by technological advancements in the sector. Therefore, since clinical knowledge is a crucial element of CDS, regular review and updating can foster successful decision-making in the health-care sector.

Alerts from EHRs and Timely Clinical Response

Evidence-based information realized through EHR system alerts bolsters early detection of conditions that could otherwise undermine the health of a particular patient. According to Simonian and Lam, EHRs also influence clinical decision support systems by integrating national performance measures for various conditions.1 In this way, alerts activated by EHR systems act as interventions, guiding clinicians to consider specific actions and decisions to improve the health of a patient. Furthermore, the response ensures that clinicians have adequate and current information before drawing their conclusions. However, it is important to manage the information acquired by the end user since too much data may interrupt the efficiency of a response. Simonian and Lam underline the concern that excessive information provided by EHR instruments can trigger cognitive overload that may result in unreliable conclusions.1

Integrating EHR in decision support systems in the health-care sector is useful in ensuring that practitioners engage in the right actions after analyzing relevant information. Simonian and Lam emphasize the need for health-care organizations and practitioners to consider integrating information and expert opinion in executing their roles and responsibilities.1 The sole use of expert advice in the early phases of CDS integration may undermine its functionality since it is important to consider pertinent information provided by systems such as EHR. According to Masys, relying solely on expert opinion may result in contentious issues that serve to raise questions about the quality of health-care delivery.4 Therefore, for CDS interventions to facilitate best practices in the health-care sector, it is crucial to deploy both expert opinions and reliable information.

Opinion

In my opinion, using appropriate and updated information in the process of health-care delivery is essential. As noted, EHR facilitates the provision of details that help clinicians develop appropriate decisions in seeking to improve patients’ health. In particular, the electronic health information system may be viewed as a way of embracing evidence-based practice to foster high-quality health-care services. According to Jones et al., relying on fact-based interventions to make care management decisions is crucial toward meeting the health-care needs of diverse patients.5 Hence, I support the need for reinforcing clinical and cognitive behavioral streams of information to foster the meaningful use of EHR and CDS systems. Streamlined information is also a fundamental supplement for CDS systems integrated into the provision of care. Such frameworks foster the decision-making aspect of care delivery. Furthermore, health-care information technologies and decision support systems (DSSs) can help to determine the extent to which expert opinion may yield effective results. In other words, as opposed to relying on professional opinion alone, I believe that incorporating EHR and CDS can foster the delivery of quality services to patients.

Knowledge Management as an Important Aspect of EHR and CDS

How Effective Knowledge Management Practices Influence CDS

Any ineffectiveness of CDS may well arise from poor knowledge management practices. Kassakian et al. identify knowledge management errors in EHR as a leading factor undermining the efficiency of CDS systems.6 In this regard, in order to realize a high standard of health-care provision, Kassakian et al. encourage clinicians to avoid practices that lead to knowledge management errors that challenge the effectiveness of clinical decision support systems in the health-care environment. Specifically, clinicians should avoid carelessly adding or removing a particular medication code from the EHR formulary list. Kassakian et al. further suggest the need for clinicians to activate a seasonal alert in the EHR system as a measure of effective knowledge management.6 Furthermore, ensuring that the base data structure undergoes appropriate changes is crucial in the effort to streamline the effectiveness of knowledge management. According to Kassakian et al., a procedure for editing alerts linked to medications should also be practiced.6 Observing the measures under consideration will go a long way in fostering EHR functionality in channeling CDS systems.

Knowledge management influences the efficiency and effectiveness of EHR and CDS by lessening errors, enhancing patient safety, and improving patients’ results. As Jones et al. assert, EHR systems go beyond containing and transmitting information by incorporating an aspect of computation that facilitates realizing meaningful outcomes for patients.5 Thus, electronic computation of patient information helps to minimize the possibility of unnecessary errors. In this view, effectively implementing EHR systems has the potential of automatically checking for the possibility of drug-drug interactions or drug-allergy interactions after prescribing a new medication for a particular patient. The system alerts the clinician about potential conflicts that may undermine the desired outcome.3 Automated assessment of such interactions plays a notable role in minimizing medication errors. As a result, the health information technology under discussion streamlines the management of knowledge to facilitate the mitigation of prescription mistakes.

According to Masys, EHR systems also foster the management of knowledge required to streamline the efficiency of CDS systems by enhancing patient safety.4 The safety of patients is an important element of care delivery today as the level of patient safety demonstrates the extent to which providers uphold the essence of quality care provision. For instance, information collected by a primary care provider and detailed in the EHR system may notify a practitioner in an emergency unit about a dangerous allergy that may undermine the health of a patient. Thus, the emergency unit clinician is enabled to offer the appropriate care regardless of the patient’s state of consciousness. In this light, as Masys observes, health-care information systems such as EHR bolster knowledge management in a way that influences effective clinical decisions.4 Therefore, the management of knowledge as aided by EHR platforms is imperative in streamlining the efficiency of CDS systems, thereby facilitating the delivery of quality care.

Adopting appropriate knowledge management practices is vital toward fostering the efficiency of CDS systems. Importantly, according to Wright et al., proper knowledge management practices enhance the ability of a CDS system to facilitate reducing medical errors while bolstering patient safety to realize quality care.3 Notably, knowledge management in CDS ensures that clinicians adhere to recommended health-care and patient treatment guidelines. Furthermore, knowledge management is important in CDS as it facilitates the mitigation of issues that arise from either inadequate levels or an overload of the information required in decision-making situations. For the long term, Wright et al. reveal how knowledge management bolsters the efficiency of CDS systems by promoting the flow of information to the extent of enhancing the quality of care.3

Adoption of Practical Knowledge Management Strategies

It is important for providers to integrate practical strategies that augment the efficiency of knowledge management. According to Masys, notable strategies that foster knowledge management in the area of CDS include incorporating analytics and adopting best-practice systems.4 The assimilation of an analytics system in the CDS facilitates knowledge management by streamlining the measurement and analysis of crucial information. This process also facilitates the creation of cross-functional teams in the health-care environment to concentrate on identifying, deploying, and evaluating the effectiveness of quality improvements.4 Implementing a system that reflects best practice is central in knowledge management for CDS, owing to its capacity to support the deployment of a data-driven strategy for the execution of evidence-based plans.

According to Middleton and Cheung, some notable strategies for bolstering the knowledge management element of health-care information technologies include codification and personalization.7 To realize EHR and CDS success, it is vital to consider embracing these key knowledge management strategies. The codification strategy contributes to the thriving of the explicit knowledge that clinicians use in the delivery of services. Notably, the codification approach to knowledge management in health-care information systems allows clinicians to capture, code, classify, and share knowledge in support of repetitive problem-solving processes. On the other hand, the personalization approach to knowledge management allows users of technologies such as EHR and CDS to apply implicit knowledge to facilitate their decision-making. The sharing of tacit knowledge among clinicians through the personalization strategy of knowledge management ensures that providers will identify novel solutions to issues that undermine the delivery of quality health-care services amid the integration of health-care information systems.

Opinion

In my opinion, knowledge management is a crucial aspect of the decision-making processes of an organization. In this regard, I endorse the need for health-care facilities to deploy information technologies, especially EHR and CDS, to uphold the essence of knowledge management since it facilitates better outcomes. As discussed earlier, the reduction of medical errors is one benefit of effective knowledge management practices that support the functionality of EHR and CDS systems. As such, I regard the adoption of appropriate knowledge management strategies as a considerable approach to the realization of best practices facilitated by health-care information technology systems. Indeed, the management of different knowledge streams in clinical practices influences the reduction of medical errors, thus bolstering patient safety. Furthermore, knowledge management supports the need for clinicians to uphold evidence-based best practices to realize maximum benefits. However, some providers engage in poor knowledge management practices that undermine the quality of care provision. As such, the overall information gathered in the selected topic regarding electronic health records and clinical decision support emphasizes adopting relevant strategies such as codification and personalization to enhance the usefulness of health-care information systems.

Improving Quality of Care through the Integration of EHR and CDS

EHR and CDS and Quality Care

The application of EHR and CDS has the potential to improve the quality of care. In particular, Berner and La Lande underline that incorporating EHR and DCS enhances the prevention of medical faults while offering health-care services to patients.8 Notably, medical mistakes are a leading factor undermining the realization of quality care provision. For this reason, it is crucial for health-care agencies and practitioners to make good use of CDS systems since they go a long way to bolster patient safety and improve the standard of care. Furthermore, according to Berner and La Lande, reducing medical errors through applying CDS and EHR is identified as an important move toward facilitating the improvement of health-care provision.8

EHR is the basis for quality improvement in the health-care sector. In particular, EHR systems facilitate the provision of accurate and complete information regarding the health status of a particular patient. According to Hicks et al., the system also offers clinicians the medical history of a specific patient, thereby ensuring that care providers use reliable information to streamline treatment processes.9 In this light, patients receive the best possible care after practitioners deploy EHR systems that are integrated into their work environments. Furthermore, according to Sherer, Meyerhoefer, and Peng, EHRs enhance the delivery of services at the point of care by encouraging collaboration between providers and patients.10 Improved patient experience plays an integral role in bolstering CDS experience following the provision of the best possible services.

EHR and CDS Reduces Clinical Faults

According to Hicks et al., EHR also enhances providers’ decision-making processes, a situation that paves the way for the delivery of error-free care.9 In particular, EHR streamlines the effectiveness of CDS systems in the health-care environment by enhancing the aggregation, evaluation, and communication of patient information. Additionally, EHR systems are typically useful in fostering the efficiency of CDS systems through the functionality of reminders as well as alerts. Furthermore, EHR systems offer considerable support to diagnostic and therapeutic decisions by ensuring that clinicians use correct and inclusive information to analyze and understand patients’ health conditions. Thus, EHR systems facilitate improved health-care delivery by protecting against possible adverse events. In this respect, EHR goes a long way to boost care delivery through its usefulness in supporting decisions realized by providers.

Incorporating CDS enhances the optimization of results facilitated by EHR systems as is evident in its capacity to reduce medical errors. In particular, according to Middleton and Cheung, CDS systems help not only in interpreting free text notes but also in retrieving data from systems such as EHR.7 It is also important to note that CDS frameworks can offer wide assistance, including preventing risky medication interactions and contraindications as well as curbing disastrous misdiagnoses. In other words, CDS bolsters the optimization of EHR by ensuring that clinicians intervene correctly to facilitate the delivery of medical services without errors, thus improving patient outcomes and the overall delivery of care.

According to Sherer, Meyerhoefer, and Peng, integrating CDS and EHR augments care delivery by cutting patients’ length of stay as well as cases of hospital-acquired infections (HAIs).10 One important function of CDS systems is facilitating the identification of deviations from the recommended evidence-based best practices in the delivery of care. Alerts indicating such deviations ensure that clinicians embrace thoroughly researched best practices to minimize the development of HAIs that may increase patients’ length of stay. In addition to protecting patients from acquiring conditions that trigger deteriorating health, information systems such as CDS and EHR can facilitate the reduction of unnecessary costs in the health-care sector. In this light, by ensuring that clinicians observe the required guidelines, CDS and EHR bolster the realization of maximum benefits for the users of a given health-care system.

Opinion

In my judgment, EHR and CDS systems are pivotal in contributing to the improvement of care provision in the health sector. Importantly, such systems offer clinicians with the reliable information that they need to administer medical interventions. It is evident that CDS and EHR complement each other in fostering the effectiveness of care delivery. In other words, these health-care information systems operate together to streamline the aggregation, evaluation, and communication of patients’ information, thus guiding appropriate interventions. This awareness informs my opinion that information technology systems contribute to the improvement of care delivery by mitigating issues such as medical errors, which are regarded as one of the inhibitors of quality health service provision.

In addition, the fact that technology systems contribute to reducing patients’ length of stay and help to prevent the development of HAIs makes their use in the health-care system considerably meaningful. The streamlined flow of information goes a long way in improving the quality of care, thus mitigating issues such as medical errors. Interestingly, CDS has been identified as fostering the optimization of EHR by paving the way for the aggregation, evaluation, and communication of patient information. Consequently, the health-care information systems under consideration curb unnecessary costs associated with prolonged stay and HAIs. In other words, EHR and CDS contribute toward the perfection of care delivery.

Conclusion

Health-care information systems, including EHR and CDS, play an important role in the delivery of care. Various components of these information technologies facilitate the flow of information to guarantee effective and efficient interventions. As this paper has revealed, creating a streamlined information flow calls for adopting relevant knowledge management practices and strategies. Providers realize the meaningful use of EHR and CDS systems in the form of improvements that can be witnessed in care delivery. Notably, these systems foster excellent care delivery by reducing misdiagnoses and medical errors and consistently providing reliable information to enhance efficiency and patient safety.

Evidently, based on the expositions made above, EHR and CDS stand out as central tools that streamline the flow of information necessary for administering health-care services. EHR systems facilitate the provision of reliable information that guides the decisions adopted by clinicians. In this respect, EHR systems have the ability to influence the reasoning aspect of care delivery by ensuring that clinicians and patients can collaborate to realize the best outcomes. The capacity of these tools to make current information rapidly available is also crucial for ensuring timely interventions and consequently the success of health-care information systems. In conclusion, it is important to note that health-care information technologies foster the realization of evidence-based practices, thereby enhancing the delivery of high-standard health-care services.

References

Simonian AI, Lam JH. Implementation of clinical decision support rules. Am J Health Syst Pharm. 2016 Apr 1; 73(7): 436-439.

Medlock S, Wyatt JC, Patel VL, Shortliffe EH, Abu-Hanna A. Modeling information flows in clinical decision support: key insights for enhancing system effectiveness. J Am Med Inform Assoc. 2016 Sep; 23(5): 1001-1006.

Wright A, Hickman TT, McEvoy D, Aaron S, Ai A, Andersen JM, Hussain S, Ramoni R, Fiskio J, Sittig DF et al. Analysis of clinical decision support system malfunctions: a case series and survey. J Am Med Inform Assoc. 2016 Nov; 23(6): 1068-1076.

Masys D. Electronic health records and genomic medicine. In: Sean D; Ginsburg G; Willard H. editors. Genomic and precision medicine: foundations, translation, and implementation. 3rd ed. Cambridge (MA): Academic Press; 2016. p. 131-142.

Jones S, Rudin R, Perry T, Shekelle P. Health information technology: an updated systematic review with a focus on meaningful use functionalities. Ann of Intern Med. 2014 Jan; 160(1): 48-54.

Kassakian SZ, Yackel TR, Gorman PN, Dorr DA. Clinical decisions support malfunctions in a commercial electronic health record. Appl Clin Inform. 2017 Sep 6; 8(3): 910-923.

Middleton B, Cheung N. Health information technology and value. In: Sheikh A; Cresswell K; Wright A; Bates D. editors. Key advances in clinical informatics: Transforming health care through health information technology. Amsterdam: Elsevier Science & Technology Books; 2017. p. 99-114.

Berner E, La Lande T. Overview of clinical decision support systems. In: Berner E, editor. Clinical decision support systems: Theory and practice. 3rd ed. New York (NY): Springer; 2016. p. 1-17.

Hicks K, Dunnenberger H, Gumpper K, Haidar C, Hoffman J. Integrating pharmacogenomics into electronic health records with clinical decision support. Am J of Health-Sys Pharm. 2016 Jan; 73(23): 1967-1976.

Sherer S, Meyerhoefer C, Peng L. Applying institutional theory to the adoption of electronic health records in the US. Info & Mngt. 2016 Jul; 53(5): 570-580.