Dr Dev Taneja’s Post

Types of Clinical Information Systems and Applications(CIS) Clinical Information System (CIS) is a computer-based system that is meant to gather, store, and alter clinical data on patients. These systems may be used at single locations or across entire healthcare systems. The purpose of CIS is to integrate, collect, store and manage data from a number of sources to support healthcare operational management, support policy decisions and manage patient data.  CIS has many benefits, including the automation of tedious manual activities, increased accuracy due to reduced human error, traceable records available from many sites of care at the same time, and connection with other bedside equipment and information systems. The built-in error checking and knowledge-based methods should also result in a more secure and high-quality clinical process. Ambulatory or Outpatient Clinical Information Systems including the Ambulatory/OPD Electronic Medical Record (EMR) Inpatient Clinical Information Systems including the Inpatient Electronic Medical Record (EMR) and Computerised Provider Order Entry (CPOE) systems. Specialty systems like the Emergency Department Information System, ICU Information System, Cardiology Information System, and Oncology Information System. Ancillary Information Systems like Laboratory Information System, Pharmacy Information System and Radiology Information System Ambulatory/OPD Clinical Information Systems When we say an OPD clinic is paperless, besides replacing paper medical records, the EMR also replaces paper lab forms and paper prescriptions.  Clinical documentation like progress notes, nursing notes and clinical notes are now done in the EMR. Order entry for lab orders, medication orders and such, are done electronically on the computer. This feature has functions like drug interaction checking, duplicate order checking and so on. A messaging or emailing system to receive and send messages like abnormal test results, and communicate via email with other members of the provider team to follow up on a patient’s care. The EMR should be well integrated with the Practice Management system to automate many back office processes, for example like triggering of a charge for a clinic visit in the billing system, after the doctor closes an encounter in the EMR. Setting up of clinical protocols and templates e.g. the protocol for pneumonia. This helps in standardizing interventions and treatments using Evidence Based Medicine (EBM) for best practice. Alerts and Clinical Decision Support (CDS) features can be set up which helps in checking for errors and improving patient safety e.g. do penicillin sensitivity test before prescribing penicillin injections. EHR and CIS systems can collaborate to give a more complete picture of a patient's health. EHR systems may draw information from CIS systems to provide precise information to decision-making clinicians, allowing them to better treat their patients.

Order Sets in Electronic Health Records Order Sets in EHR provide simultaneous ordering of all necessary components associated with effective clinical care such as lab tests, x-rays, and medications. Order Sets are efficient for the provider and can lead to better care. Order sets represent one CDSS tool within CPOE systems that may promote safe, efficient, and evidence-based patient care. A small number of order sets account for the vast majority of use, suggesting that some order sets have a higher value to clinicians than others. EHR order sets can save time and improve processes of care, Order set success requires leadership, planning, and resources as well as ongoing maintenance and evaluation. Order Sets can help providers to remember to order all the necessary components(investigations & Treatment) of an disease. Order sets apply clinical decision support (CDS) at the point of care and either focus on a specific condition (e.g., asthma) or are generalized for use in many scenarios. Evidence-based orders decrease the chance of omitted orders and pave the way for best practice implementation over the course of usage, review and redeployment. Use of EHR-based order sets takes the care quality process to a higher level, improving consistency of treatment and patient safety and reducing patient mortality and hospital costs through decreased lengths of stay. Seven recommended key methods. 1. Secure administrative support Order set development is a corporate-wide initiative fully supported by the administration and performed in stages  2. Plan before you build Determine your current orders workflow processes and identify the bottlenecks to eliminate. 3. Enlist subject matter experts Recruit physicians, nurses, pharmacists as subject matter experts (SMEs) to engage in order set design specific to their expertise.  4. Develop a communication plan Communication among all members of the build team must flow efficiently or the process will stagnate.  5. Apply the 80/20 rule. Build for the most common orders used approximately 80 percent of the time. Providers can add the other 20 percent later. Keep order set length as short as possible to avoid physician dissatisfaction. Use common sub-sets such as common IV fluids and DVT/VTE prophylaxis orders. Notes within order sets should be pertinent to procedures and patient safety, and include evidence links when possible.  Keep the use of notes and reminders to a minimum and create organized “libraries” of order set components. 6. Allow for provider training Moving from paper to an EHR system with computerized physician order entry (CPOE) creates a steep learning curve for many providers. Schedule training for order sets months in advance of the intended go-live so that physicians can clear their schedules. 7. Conduct annual reviews and change control. As new evidence becomes available and better drugs and treatments become known, order sets must be updated to reflect these changes.

Medication errors are a serious threat to patient safety and quality of care. According to a recent article by The Jerusalem Post https://lnkd.in/gEHGKgQA, a software glitch across Israel's hospitals caused an undetermined number of patients to receive incorrect discharge prescriptions through discharge letters. While the lack of detail makes it impossible to speculate on the seriousness of the hazard in this case, all medication errors have the potential to cause harm. As a doctor and Healthcare IT consultant, I found this article both alarming and informative. It highlights the importance of ensuring the accuracy and reliability of digital health systems, especially in the context of medication management. 1. Performing a discharge medication reconciliation could detect these problems early (depending on where the error occurred): Discharge medication reconciliation is the process of comparing the patient's medication list before admission, with those prescribed at discharge, and resolving any discrepancies or changes. It is a critical component of medication management and continuity of care, as it helps to prevent medication errors, adverse drug events, and readmissions. Performance of a discharge medication reconciliation by doctors or clinical pharmacists could highlight any mismatches, allowing these to be corrected before sending discharge letters. 2. Artificial Intelligence and other Clinical Decision Support mechanisms could play a role in EMRs, checking for incongruent and outlying data and flagging anomalies: For example, AI could compare the medications in the EMR with the medications in the discharge letters, or verify the appropriateness of medications and dosages based on factors such as the patient's age, renal function, and conditions. 3. Including the patient in their care: Patient participation in their own care is being targeted by organisations and governments and is included in the Australian government's recently published Digital Health Blueprint. If patients are walked through the relevant aspects of their discharge letters before leaving hospital, such errors may be detected at an early stage. 4. EMRs and other digital tools augment, but should not replace, clinician thinking and communication: Clinicians must take responsibility for the information in a patient's record, regardless of the medium. Even with digital systems, human oversight and verification are essential to ensure the validity and completeness of the data. Educating users about the functionality and limitations of Health IT systems is crucial when implementing them, as it helps to avoid excessive dependence and unrealistic expectations of the systems' capabilities. In addition to the points above, it is important to remember that processes like prescribing are not carried out in a vacuum - a whole systems approach is necessary for delivering safe and reliable healthcare and preventing errors.

Appropriate use criteria (AUC) in Clinical Practice Appropriate use criteria (AUC) in clinical practice refer to guidelines and recommendations that help healthcare providers make informed decisions about when and how to use specific medical tests, treatments, or procedures for a given patient's condition. AUC are designed to promote the delivery of effective, safe, and cost-efficient healthcare by ensuring that medical interventions are used appropriately based on the individual patient's clinical circumstances. Guideline-Based Decision Making: AUC are typically developed based on clinical practice guidelines, which are evidence-based recommendations for managing specific medical conditions. Clinical Scenarios: AUC provide recommendations for different clinical scenarios or patient presentations. These scenarios take into account factors such as a patient's symptoms, medical history, and risk factors. The goal is to match the recommended intervention to the specific clinical context. Rating Scales: AUC often use rating scales to categorize the appropriateness of a medical intervention for a given clinical scenario. Common categories include "appropriate," "may be appropriate," and "rarely appropriate." These ratings help guide clinical decision-making. Multidisciplinary Input: The development of AUC typically involves input from multidisciplinary panels of healthcare experts. These panels may include physicians, nurses, researchers, and other relevant professionals who review and analyze available evidence. Shared Decision-Making: AUC can facilitate shared decision-making between healthcare providers and patients. By considering the appropriateness of various options, patients can actively participate in choosing the most suitable treatment or intervention for their condition. Quality Improvement: AUC are used as tools for quality improvement in healthcare. They can help identify situations where medical interventions are overused, underused, or misused, leading to improvements in care delivery. Resource Allocation: AUC can aid in the efficient allocation of healthcare resources. By guiding the appropriate use of tests and treatments, healthcare systems can avoid unnecessary costs and optimize resource utilization. Research and Education: They are used to inform healthcare professionals about the latest evidence-based practices and are often integrated into medical training programs. Monitoring and Adaptation: Healthcare organizations and providers should regularly review and update their AUC to reflect current best practices. Regulatory and Reimbursement Considerations: Meeting AUC can impact a healthcare provider's eligibility for reimbursement for certain procedures. Appropriate use criteria serve as valuable tools for promoting evidence-based and patient-centered care while ensuring the efficient use of healthcare resources.

Revolutionizing Healthcare: Ambient Clinical Documentation. The recent HIMSS conference in Orlando, Florida, showcased a groundbreaking advancement in healthcare technology: ambient clinical documentation. Developed by industry giants like Microsoft's Nuance Communications, Abridge, and Suki, this innovation leverages artificial intelligence (AI) to streamline the process of documenting patient encounters, offering unprecedented benefits to both physicians and patients. Ambient clinical documentation automatically transcribes conversations between doctors and patients into comprehensive clinical notes and summaries using AI algorithms. This eliminates the need for manual transcription, saving time and resources for healthcare providers. Physicians can now focus entirely on patient care, confident that their interactions are accurately captured in real-time. This technology offers customization options to meet the unique needs of different medical professionals and specialties. Whether in cardiology, oncology, or pediatrics, ambient clinical documentation adapts to specific documentation requirements, ensuring accuracy and relevance in every clinical encounter. Personalized documentation enhances efficiency and improves the quality of patient care. Ambient clinical documentation seamlessly integrates into existing Electronic Health Records (EHR) systems, such as Epic Systems. Physicians can access and utilize the technology without switching between applications, streamlining workflow and enhancing efficiency. This ease of integration accelerates adoption across healthcare systems, paving the way for widespread implementation. By automating clerical tasks, ambient clinical documentation alleviates the administrative burden on physicians, addressing the pervasive issue of burnout. With less time spent on paperwork, doctors can devote more energy to direct patient care, improving provider satisfaction and patient outcomes. This technology fosters a more patient-centered approach to healthcare. By freeing physicians from paperwork, ambient clinical documentation enables them to prioritize face-to-face interactions with patients. Stronger doctor-patient relationships fostered through personalized care experiences enhance overall care quality. This shift towards patient-centric care benefits individual patients and contributes to broader cultural transformation within the healthcare industry. Ambient clinical documentation heralds a new era of efficiency and personalization in patient care. Rapid adoption underscores its potential to reshape the healthcare landscape, offering a glimpse into a future where technology supports and enhances healthcare providers' work seamlessly. Embracing this transformative technology moves us towards a healthcare system that is more efficient, compassionate, and patient-centric.

📌 Staying Informed: The Critical Need for Doctors to Stay Updated with Medical News In the rapidly evolving field of medicine, staying updated with the latest news, research, and advancements is not just beneficial but essential for healthcare professionals. Doctors, as the frontline providers of medical care, bear the responsibility of integrating the most current information into their practice to ensure the highest standards of patient care. Here’s why doctors must remain informed about the latest developments in the medical field: 1. Enhances Patient Care and Outcomes By staying updated with the latest medical news, doctors can incorporate new diagnostic tools, treatments, and best practices into their patient care strategies. 2. Facilitates Evidence-Based Practice By keeping abreast of new studies and clinical trials, doctors can make informed decisions that align with the most current evidence. 3. Prepares for Emerging Health Threats The medical landscape is constantly changing, with new diseases, outbreaks, and health challenges emerging regularly. Staying updated with medical news enables doctors to be better prepared for these threats. 4. Enhances Interdisciplinary Collaboration Staying informed about the latest developments across various medical fields facilitates better communication and coordination, leading to more integrated and comprehensive patient care. 5. Encourages Innovation and Improvement Whether through participating in clinical research, adopting new technologies, or developing novel treatment protocols, informed doctors play a key role in driving medical progress and improving healthcare delivery. 6. Increases Patient Trust and Confidence Patients trust doctors who are knowledgeable and up-to-date with the latest medical advancements. This trust is essential for effective patient-doctor relationships, adherence to treatment plans, and overall patient satisfaction. Conclusion In the dynamic and ever-evolving field of medicine, the importance of staying updated with the latest news and developments cannot be overstated. By staying informed, doctors not only improve their own practice but also contribute to the broader advancement of healthcare, ensuring that patients receive the most effective and cutting-edge treatments available. The commitment to staying current is a cornerstone of medical professionalism and a fundamental aspect of delivering high-quality, patient-centered care.

Clinical leadership plays a crucial role in healthcare settings, and its importance cannot be overstated. Clinical leadership involves healthcare professionals taking on leadership roles to improve patient care, enhance the overall quality of healthcare services, and drive positive changes within healthcare organizations. Here are some key reasons why clinical leadership is essential: 1. **Improved Patient Outcomes:** Clinical leaders focus on evidence-based practices and patient-centered care. Their leadership can lead to better clinical outcomes, reduced errors, and improved patient safety. 2. **Effective Decision-Making:** Clinical leaders are often involved in making critical decisions about patient care. Their expertise and experience contribute to informed and effective decision-making, especially in complex medical situations. 3. **Quality Improvement:** Clinical leaders drive initiatives to enhance the quality of care provided by setting and monitoring standards, implementing best practices, and continuously evaluating and improving healthcare processes. 4. **Innovation and Research:** Clinical leaders often engage in research and innovation, pushing the boundaries of medical knowledge and technology to improve treatments and outcomes for patients. 5. **Team Collaboration:** Effective clinical leaders promote teamwork and collaboration among healthcare professionals. They facilitate interdisciplinary communication, fostering a culture of cooperation that benefits patients and staff. 6. **Patient-Centered Care:** Clinical leaders emphasize patient-centered care, ensuring that healthcare services are tailored to meet the individual needs, preferences, and values of patients. 7. **Resource Allocation:** Clinical leaders play a role in optimizing resource allocation, ensuring that healthcare facilities have the necessary equipment, staffing, and resources to provide high-quality care. 8. **Education and Training:** They are often involved in mentoring and training the next generation of healthcare professionals, passing on their knowledge and skills to ensure a well-prepared healthcare workforce. 9. **Advocacy:** Clinical leaders advocate for their patients and the healthcare system, working to address systemic issues, healthcare disparities, and policy changes that benefit patients and healthcare providers. 10. **Change Management:** In an ever-evolving healthcare landscape, clinical leaders are instrumental in leading and managing change initiatives, adapting to new technologies, regulations, and best practices. 11. **Patient Safety:** Clinical leaders champion patient safety efforts, implementing safety protocols and fostering a culture of continuous improvement to reduce medical errors and adverse events. 12. **Ethical Decision-Making:** They navigate complex ethical dilemmas, ensuring that healthcare decisions are made with integrity, compassion, and a commitment to ethical principles.

Should there be any limits to medical tests on patients? There should be limits to medical tests on patients to uphold ethical standards and provide responsible and patient-centered healthcare. The foundation for establishing these limits lies in the principle of medical necessity. Medical tests should be ordered based on clinical indications and the genuine need to gather relevant diagnostic information. This ensures that tests are aligned with the patient's symptoms, medical history, and have the potential to influence treatment decisions positively. It discourages unnecessary or redundant testing that may not contribute meaningfully to patient care. Unnecessary or excessive testing can contribute to escalating healthcare costs and create challenges in resource allocation. Tests should be selected based on their ability to provide valuable information that directly contributes to improved patient outcomes, avoiding superfluous expenditures. Before proceeding with any test, patients have the right to be fully informed about the purpose, benefits, risks, and potential alternatives. Informed consent ensures that patients are actively involved in their healthcare decisions and can make choices that align with their values and preferences. A commitment to evidence-based practice is essential in guiding medical testing. Tests should be recommended based on established clinical guidelines and supported by scientific research. This ensures that diagnostic procedures are aligned with the best available evidence, promoting consistency and reliability in healthcare practices. Excessive testing can lead to overdiagnosis and overtreatment, where conditions are identified that may not actually require intervention, potentially causing harm to patients. Privacy and confidentiality are paramount when conducting medical tests, as they involve the collection of sensitive information. Medical tests should not be used for non-medical purposes, such as satisfying curiosity or accommodating patient demands without clinical justification. Responsible and ethical use of medical testing ensures that each diagnostic procedure serves a legitimate medical purpose and contributes to the patient's overall care. In the contemporary healthcare landscape, adopting a patient-centered approach is crucial. Shared decision-making between healthcare providers and patients involves transparent communication about the necessity, benefits, risks, and potential alternatives to medical tests. By balancing the need for diagnostic information with patient safety, well-being, and responsible resource utilization, healthcare professionals can ensure high-quality and ethical healthcare practices.

Clinical Innovation: 11 Eye-Opening Insights: 1. The Slow Adoption Paradox 🐢- Despite solid evidence supporting them, many proven clinical innovations take an unexpectedly long time to become standard practice, often hindered by institutional inertia and regulatory barriers. 2. Incremental Disruption🔍: Contrary to popular belief, significant advancements in healthcare often emerge from modest, incremental changes rather than monumental breakthroughs. 3. Failure as a Stepping Stone🔄: The path to successful medical innovations is frequently paved with past failures. Each unsuccessful attempt contributes insights, shaping the eventual breakthrough through iteration. 4. Access vs. Outcome Dilemma⚖️: Increasing healthcare access is universally positive, yet it doesn't always equate to better health outcomes. In some instances, this can lead to overdiagnosis and overtreatment, especially in societies with a high medicalization culture. 5. The Complexity of Simplicity🧩: Ironically, implementing simple clinical innovations, such as standardized protocols, can be surprisingly challenging. Changing human behavior often proves more difficult than technological advancements. 6. Inequality Amplified by Innovation🌍➗: Cutting-edge treatments may inadvertently exacerbate healthcare disparities, often being accessible predominantly to affluent groups, while marginalizing lower-income communities. 7. Regulatory Hurdles as Innovation Catalysts🚧: Regulation can unexpectedly encourage creative problem-solving and drive innovation. 8. Non-adherence as an Innovation Driver💊🔄: Patient non-compliance, a notorious healthcare challenge, ironically fuels inventive approaches in patient education, medication delivery, and digital health technologies. 9. Provider Resistance to Change⚠️ : Healthcare professionals are a conservative bunch, frequently resisting change. This reluctance is less about the effectiveness of these innovations and more about the disruption to established workflows and practices. 10. The Cost-Effectiveness Conundrum💵💡: Some of the most impactful medical innovations may not be the most cost-effective. In certain cases, simpler or less expensive alternatives can yield comparable results, challenging the notion that newer always equates to better. Bonus Insight: 11. Technological Overemphasis🤖❌: The healthcare sector often places disproportionate emphasis on high-tech solutions. Yet, it's the low-tech or straightforward interventions that can sometimes deliver more substantial health benefits. What other counter-intuitive facts come to mind in healthcare innovation?

Order Sets in Electronic Health Records Order Sets in EHR provide simultaneous ordering of all necessary components associated with effective clinical care such as lab tests, x-rays, and medications. Order Sets are efficient for the provider and can lead to better care. Order sets represent one CDSS tool within CPOE systems that may promote safe, efficient, and evidence-based patient care. A small number of order sets account for the vast majority of use, suggesting that some order sets have a higher value to clinicians than others. EHR order sets can save time and improve processes of care, Order set success requires leadership, planning, and resources as well as ongoing maintenance and evaluation. Order Sets can help providers to remember to order all the necessary components(investigations & Treatment) of an disease. Order sets apply clinical decision support (CDS) at the point of care and either focus on a specific condition (e.g., asthma) or are generalized for use in many scenarios. Evidence-based orders decrease the chance of omitted orders and pave the way for best practice implementation over the course of usage, review and redeployment. Use of EHR-based order sets takes the care quality process to a higher level, improving consistency of treatment and patient safety and reducing patient mortality and hospital costs through decreased lengths of stay. Seven recommended key methods. Secure administrative support Order set development is a corporate-wide initiative fully supported by the administration and performed in stages  Plan before you build Determine your current orders workflow processes and identify the bottlenecks to eliminate. Enlist subject matter experts Recruit physicians, nurses, pharmacists as subject matter experts (SMEs) to engage in order set design specific to their expertise.  Develop a communication plan Communication among all members of the build team must flow efficiently or the process will stagnate.  Apply the 80/20 rule. Build for the most common orders used approximately 80 percent of the time. Providers can add the other 20 percent later. Keep order set length as short as possible to avoid physician dissatisfaction. Use common sub-sets such as common IV fluids and DVT/VTE prophylaxis orders. Notes within order sets should be pertinent to procedures and patient safety, and include evidence links when possible.  Keep the use of notes and reminders to a minimum and create organized “libraries” of order set components. Allow for provider training Moving from paper to an EHR system with computerized physician order entry (CPOE) creates a steep learning curve for many providers. Schedule training for order sets months in advance of the intended go-live so that physicians can clear their schedules. Conduct annual reviews and change control. As new evidence becomes available and better drugs and treatments become known, order sets must be updated to reflect these changes.