Transforming the EHR into a knowledge platform to ensure improved health and healthcare
This is a review of the white paper by Ian Chuang, M.D. for Health Information Management Systems Society (HIMSS) entitled, Transforming the EHR into a knowledge platform to ensure improved health and healthcare.
Background and Purpose
The focus of this whitepaper is to promote EHR implementation best practices and emphasizes how an EHR system provides a knowledge platform for clinical decision support and optimization of care processes.
Data should seamlessly be available at the multiple times during a patient encounter when care decisions are being made. With a paper system, information is often missing or there is an overwhelming amount of information and care is compromised. Clinical decision support should be designed to guide clinicians with relevant, timely information at the appropriate point in the workflow. “What is presented, how it is presented and when it is presented are crucial to the user acceptance and improve clinical outcomes” (p. 3,  ).
Knowledge flow is the integration of decision support into care processes in a way that creates a process of continuous improvement. Elements to be considered to ensure proper knowledge flow:
- Data availability (at the point of care)
- Data accessibility downstream (who will need the data later?)
- Data understandability and usability
- Data transformation (data to information to knowledge)
- Data deliverability (passive, proactive or combination)
Clinical decision support should be an integral part of EHR design and should allow for varying levels of presentation. Ideally, the level of clinical decision support (CDS) should be configurable by the user. The lowest level is a straightforward, passive reminder. Informative CDS gives additional description. Educational CDS might offer extensive evidence-based enabling the provider to take specific actions for optimization of patient care.
The author makes an interesting point that designers should shift thinking towards knowledge flow instead of the tradition focus on data flow. So, given a specific end goal (measureable outcome improvement) design in what key decisions must be incorporated into the workflow to ensure the goal is met. These knowledge-oriented flows are designed into the system beforehand with the possibility of 'learning' through constant quality improvement.
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- < Chuang, I., Health Information Management Systems Society (HIMSS). (October, 2014). Transforming the EHR into a knowledge platform to ensure improved health and healthcare. Retrieved from http://s3.amazonaws.com/rdcms-himss/files/production/public/FileDownloads/2014-10-17%20Netsmart%20White%20Paper%20Transforming%20the%20EHR.pdf