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Executive Summary
Reminders are elements of clinical decision support (CDS) that can be an effective mechanism for improving adherence to clinical guidelines. Greater adherence can lead to improved health care quality and safety, especially for patients with chronic diseases, and may help clinicians participating in pay for performance (P4P) initiatives.
Using a grant from AHRQ, the Partners HealthCare System Quality Improvement Group developed pediatric rules and reminders for the ambulatory environment. These rules and reminders are available for download by others as an example and guide with the hope that other ambulatory practices will adopt CDS rules and reminders to improve quality and safety.
To download the rules and reminders, use the links to the right.
Overview
CDS reminders viewed by clinicians while interacting with an electronic health record (EHR) can be an effective mechanism for improving adherence to clinical guidelines. Greater adherence to guidelines has been demonstrated to improve health care quality and patient safety, especially for patients with one or more chronic conditions (e.g., diabetes, asthma). Reminders may also help clinicians who are engaged in pay for performance (P4P) initiatives.
Despite their utility, reminders frequently need to be created de novo, and they often require modification to suit a given practice environment. The process to create and modify reminders can be time consuming and costly to undertake, a task unrealistic for many solo practitioners or small group practices.
Under the AHRQ-funded grant Improving Pediatric Safety and Quality with Healthcare IT, the clinicians and administrators created pediatric reminders for the ambulatory environment along with the underlying CDS rules that trigger them within the EHR. These rules and reminders were designed to enhance care both at health maintenance visits as well as at encounters for managing chronic conditions. This work was done in collaboration with the Partners HealthCare System Pediatric Quality Improvement Group, the Massachusetts General Hospital for Children, and Partners HealthCare Systems Inc. Information Systems in Boston, MA. These pediatric reminders are currently in use in the Partner's EHR, known as the Longitudinal Medical Record.
The rules and reminders are based on guidelines at both the national and state level, as well as local expert consensus. The rules define the scope and criteria needed to generate a reminder. For example, if a patient meets the following criteria "Gender = female and Age < 26 years and Oral Contraceptive on medication list and has no record of Chlamydia test in last year," the following reminder will be generated "Contraceptive is on medication list. If patient is sexually active, screen for Chlamydia." The rules may be built into an EHR system in order to generate reminders as the criteria are met.
These rules and reminders are being shared with the health IT community in order to provide clinicians with examples that can be implemented into their own EHR system. Users may select a subset of these and customize them based on the needs of their practice population. The aim is for these examples to ease the implementation process for others, which supports the goals of achieving greater adoption of CDS rules and reminders, improving compliance with clinical guidelines, and improved efficiency and workflow within a practice environment.
Disclaimer
These rules were generated using national, state and local guidelines, and group consensus regarding best practices. These guidelines and their interpretation by clinicians at Partners Healthcare System may not represent the standard of care across all regions or settings, and they are not intended to be adopted or applied without independent assessment as to their application in the setting in question. Moreover, guidelines change over time (for example, the age range for children who should receive influenza vaccinations was recently extended to 59 months), and thus the rules and/or reminders may necessitate the addition or modification of certain items to ensure that they remain consistent with current guidelines. Accordingly, the rules and reminders available here are intended only as examples or guides for the development of such rules or reminders in other settings. Partners Healthcare System and its affiliates disclaim any and all responsibility or liability associated with the use of the rules and/or reminders displayed here by third parties.
