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CDS 5 Rights Framework for Targeted Performance Improvement Efforts
(Adapted from multiple figures in chapter 3 of 2005 HIMSS CDS guide, and Table 1-2 in 2009 HIMSS CDS guide)
The purpose of this table is to assist CDS implementers in thinking through configuration details for CDS interventions that address a specific clinical target. These targets may include increasing use of medications or tests indicated for specific conditions, reducing specific healthcare associated complications such as nosocomial infections, decreasing specific medication errors, reducing readmissions, and related imperatives associates with healthcare reform, meaningful use, pay-for-performance and related drivers.
For any given improvement target for CDS interventions, implementers can use this table as a starting point for determining opportunities in clinical workflow for providing CDS to address the target, CDS intervention types that might be delivered at that point, recipients of the intervention, and channels through which the information can be delivered. The fifth 'CDS Right' - i.e. 'Right Information' - will depend on the specific target of interest. For example, to improve use of VTE prophylaxis, it might consist of information to determine appropriate prophylaxis to be given, and administration recommendations for that prophylactic approach .
Outside in-person encounters | Encounter-based Workflow/Interventions
|
Workflow
(When)
|
Population Management
|
Pre-visit
|
Admin Intake
|
History and
examination
|
Shared decision making
|
Orders
|
Data Review
|
Education
|
Discharge
|
|
Format
(How)
|
Rules (surveillance)
RDD
Ed/Ref
|
Rules (dz/drug)
RDD
Questionnaire
Ed/Ref (for concerns)
Provider msg
IB
|
Rules (flag for protocol)
|
Documentation tools (problem-specific flowsheets, risk assessment)
Rules (for complete
data gathering)
|
Ed/ref
Shared decision tools
|
Order facilitators (standing, sets)
Rules (drug/dz, safety and best practice)
IB (drug/dz info)
RDD (labs, costs)
|
RDD (flowsheet, highlight probs)
Rules (proactive notice)
IB (results interpretation/ action)
|
Ed/Ref
|
RDD (D/C summary)
Rules (for D/C meds, ec.)
|
|
Person
(Who)
|
Case Manager
Clinician
Consumer
|
Patient
Case manager
Clinician
|
Intake admin
patient
|
Nurse
Physician
Patient
|
Patient
Clinician
|
Prescriber
Patient
|
Clinician
Patient
|
Clinician
Patient
|
Nurse
Physician
Patient
|
|
Channel
(Where)
|
Registry
EHR
Admin DB/tool
HIE
PHR
|
PHR
Provider Portal
|
EHR (admin)
Paper forms
|
EHR (clin doc)
Paper forms
|
EHR
Internet
Stand-alone systems
|
CPOE
Paper forms
Internet
Paper sources
|
EHR (lab, ref sources)
Internet (refs)
Paper sources
|
EHR
Internet
Paper sources
|
EHR (D/C module, Med Rec app)
Paper tools/forms
|
Glossary:
RDD=Relevant data display
Questionnaire= health risk appraisal, etc.
IB=infobutton
Provider msg=structured messaging (e.g. problem-focused) between patient and provider
Ed/Ref=education/reference materials
Clinician=physician, nurse, pharmacist
Clin doc=clinical documentation system
Admin DB=administrative database
HIE=health information exchange
PHR=personal health record
Admin sys=administrative intake system
Clin Doc=clinical documentation module
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Comments (2)
lozeran said
at 4:13 pm on Jul 17, 2010
In context, it probably makes perfect sense, but naked, out of context above, the table needs some explanation. The table appears to be areas or processes where CDS may bring benefit to an organization. If so, as little as one sentence under the title or below the table which explains what the table data means, why it is useful, would make it so.
Donald Levick, M.D., MBA said
at 7:14 am on Jul 20, 2010
The Framework needs to be approachable and easy to follow and guide the users or committee through the identifying and prioritizing the CDS efforts.
The current CDS 5 Rights Framework contains very useful information; however the organization of the Framework makes it difficult to follow.
I think that most organizations think of the end product first – “reducing VTE’s” or “Improving appropriate post-op antiobiotic use,” prior to considering where in the encounter process that the CDS impact should occur.
Consequently, I think the Framework could re-organized as a branching algorithm.
• It could start with the “WHAT” as mentioned in the Note below the Framework.
• The next step would be “WHEN” – and this would branch into Population Based vs. Encounter Based. This would depend on whether the target was an pt-specific condition (i.e. drug-drug interactions, allergy alerts), or a global population based intervention (i.e. diagnosis specific order sets, etc.).
• Based on the first two steps, the “WHO” could be answered next. This would identify the target for the CDS intervention. The listing on the Framework captures those targets.
• The “WHERE” could be addressed next. This step identifies the Channel for delivery of the CDS intervention, as currently displayed on the Framework.
• Finally, the “HOW” identifies the actual intervention – alerts, order sets, input forms, reference sites, etc.
The “Clinical Objective Value Score” (Figure 1-8 from the first book) is also very valuable and can be integrated into this process. I think it is a great tool for CDS Committees to prioritize their efforts. It works in parallel to the Framework, as both tools require identification of target audiences and the overall impact. I think that one tool can inform the other. The Score will clearly impact the decisions of which potential CDS interventions are considered and mapped out via the Framework .
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