How To Enhance Clinical Content Management

With the advancement of clinical research, clinical content management has become a priority and critical force towards success within quality-based reimbursement models.

How To Enhance Clinical Content Management

Health-care organizations are recognizing that leveraging technological infrastructures to deliver the most up-to-date clinical decision support to clinicians at the point of care is not only essential to meet regulatory requirements but also improve the outcomes and expenses.

Within any hospital’s greater CDS strategy, use of order sets has been identified by leading industry analysts as a key element for driving uptake of evidence-based practices and guiding clinicians to make the best decisions. The challenge is laying a framework for long-term viability of these tools as deployment, implementation and ongoing maintenance can be complex undertakings for the average resource-strapped healthcare organization.

While one notable hurdle to fully leveraging order sets is the ongoing maintenance activity required to keep content aligned with industry best practices, staying abreast of evolving regulatory guidelines for performance is equally challenging. Manual processes and workflows for identifying needed changes within a fluid regulatory landscape and rapidly advancing scientific field often result in compliance challenges and outdated evidence.

Rockford, III.-based Swedish American responded to these challenges by deploying a two-pronged strategy based on advanced clinical content management technology and governance. The health system comprises of a large care hospital unit, medical centre and comprehensive network of outpatient providers and clinics, has been able to significantly streamline order set review and editing by applying quality assessment to the front end instead of the back end of processes.

Identifying Opportunities

The SwedishAmerican fosters a culture of ongoing process improvement. The organization’s well-honed clinical content management infrastructure and governance model for maintaining order sets are an outgrowth of that culture and designed to lay a foundation for sustainability with CPOE and evidence-based practices.

As part of SwedishAmerican’s larger governance strategy, the clinical informatics team conducts reviews of the organization’s approximately 230 order sets to ensure compliance with industry best practices and national quality measures. Governance is built on three guiding principles: 1) always put the emphasis of the patient first, 2) clinical users play an integral role in clinical IT decisions; and 3) the IT decision process is standardized, transparent and responsive.

Until recently, a typical quality review process entailed meeting with clinical staff to review new evidence recommended through the comprehensive clinical content management system— ProVation Order Sets, powered by UpToDate Decision Support. Upon physician approval of edits and changes, content was forwarded to one of SwedishAmerican’s 7 quality analysts for review to ensure edits were done with quality initiatives. Revisions by quality reviewers were then sent back to the designated physician for reexamination.

A Good Strategy For Quality Review

Recognizing the significant resources required to keep order sets in synch with national quality measures, the SwedishAmerican clinical informatics team identified a strategy for streamlining the effort while also minimizing the potential for compliance gaps. It required that a quality assessment be applied to the front end of order set review rather than the back end by leveraging tools within the existing clinical content management infrastructure.

An automated system comprised of up-to-date national quality measures and customized rules is now used to conduct on-demand gap analyses of order sets and alert the clinical informatics team when content critical to quality measures is omitted or when content deviates from regulatory standards. As revisions are requested, compliance issues can be identified on the front end, eliminating the constraint that would previously occur.

When the new workflow and governance strategy was introduced, clinical informatics team leaders held an initial meeting with appropriate quality personnel to identify corresponding rules within abstracting methods for various national quality measures. The initial brainstorming proved beneficial as staff were able to identify opportunities to eliminate duplicated efforts between nursing and quality review. Staff also gained critical insight into the potential impacts of rules on clinical practice.

During the initial review of existing order sets, SwedishAmerican was encouraged to find that very few gaps existed with national quality measures—the most common associated with surgical care improvement project (SCIP) measures for preoperative patients. Overall the implementation of the new workflow has enhanced clinical practice, and staff is confident that measures align with regulatory initiatives and most important: patient care is optimized.

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