CIA Principle 3: Patient Information is Designed to Support Care First.
“Capture and Use of Patient Information is Designed to Support Care delivery across the region: first for points of care, then for points of reflection.”
Clinical Information Architecture must support all of the following:
1. Point of care activities, with providers interacting with the system.
2. Future Point of Care with the same patient.
3. Point of Reflection activities: practice improvement to health planning
First, the capture of clinical information in the ePtHR must support the current clinical activities by providing documentation support, decision support, process support.Clinical decision support includes prevention, promotion, and guidance for current activities.
Data must be captured in a way that the ePtHR supports future clinical activities. Data is designed so that it can be repurposed for different clinical views amongst the care team and for use in future encounters. Data can be trended over time. Management plans are shared, with activities available to each team member. Context of information is maintained.
Finally, the design should support aggregating information so that the information can be used as health-planning information. Local quality improvement exercises and larger, regional health planning are to be supported. The design should support extracting evidence from practice to improve future care (practice-based evidence). The design should support extractions for deidentified and anonymized reporting information to the Ministry of Health, CIHI, etc.
Not providing a clear information design up front may preclude the effective use for advanced EHR functionality, will limit the reuse of information, and impact health-planning activities. In short, without thoughtful information architecture, VIHA could have a regional Electronic Paper Record.
Commentary:
This principle brings in two of my favorite terms: Point of Reflection and Electronic Paper Record.
More importantly; however, I think this principle puts squarely out front the clinical and care needs over the reporting needs. This is important as it is sometimes all too easy to avoid or not complete the analysis on the nebulous, ill articulated and, often, conflicting care and user requirements when there are shiny, documented and specific reporting / planning data requirements (which are often mandated requirements as well). I think it is important to focus on the clinical needs first for two reasons: we are in the business of care delivery and if we cannot motivate our providers to data enter (by making it useful) we’ll have poor data for analysis.
Billing data in BC is a good example of this principle. Rarely do providers make sure that the ICD codes in billing truly reflect all the conditions as accurately as possible in order to bill. Instead, they satisfy the “infernal machine” with the minimum and vaguest codes possible. BUT, if you pull your billing codes from your assessment field in your clinical note (that also helps drive the care plan), you’re likely to get more specific and accurate data.
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