Knowledge Activity: Implementing Clinical
Decision Support (Master’s)
Questions
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*For questions that ask for percentages, round your answer to the nearest percentage.
1. The Smoking Cessation CDS protocol was implemented at the Central Clinic one year
ago. Of the 500 patients included in the report population, what percentage of
patients were seen in the Clinic within the last 12 months?
Of the 500 patients in the pivot table, only 261 or 52% of the 500 patients
were seen at the Central Clinic within the last 12 months.
2. What percentage of patients in the report population were not seen in the Central
Clinic within the last 12 months?
Of the 500 patients in the pivot table, 239 patients have not been seen in the
Central Clinic in the last 12 months or 48%.
3. Based on the data in the report and the implementation period of the Smoking
Cessation CDS, what number of patients should be included in the evaluation criteria
for the CDS goals?
sh
Th
261 patients should be included in the evaluation criteria for the CDS goals.
They are the patients that were actually seen during the implementation
period of the CDS protocol. If the patient has not been in to the clinic, then
their smoking status cannot be assessed and the related areas following
assessment, such as encouragement of quitting and being provided with
smoking cessation literature cannot be completed. Only patients seen during
the 12 month CDS protocol period should be included in the evaluation
criteria.
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4. Of the patients who were seen in the clinic during the last 12 months, what
percentage have a known smoking status in their problem list?
Of the 261 patients that were seen in the clinic in the last 12 months, only 93 or 36% of
them have a known smoking status in their problem list.
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5. Of the patients who were seen in the clinic during the Smoking Cessation CDS
protocol, i.e. during the last 12 months, for what percentage is smoking status
unknown, i.e. either not assessed or not documented in the problem list?
Of the 261 patients that were seen in the clinic in the last 12 months, 168 or 64% of
them do not have a known smoking status at all in their problem list. Their status is
unknown.
6. Of the patients who were not seen in the clinic during the Smoking Cessation CDS
protocol, i.e. not seen in the Clinic during the last 12 months, for what percentage
was smoking status known, i.e. either current smoker or never smoker?
31% or 75 patients who were not seen in the clinic during the Smoking Cessation CDS
protocol, (not seen in the Clinic during the last 12 months) have a known smoking status.
7. How many more patients who were part of the CDS protocol during the last year
have an identified smoking status than patients who were not included in the CDS
protocol, i.e. not seen in the Clinic over the last 12 months?
Th
There are 18 more patients who were part of the CDS protocol during the last year that
have an identified smoking status than patients who were not seen in the Clinic over the
last 12 months.
sh
8. Is it much more likely that the Clinic has identified a patient’s smoking status under
the new CDS protocol? Explain and quantify your answer.
It is only minimally more likely that the Clinic has identified a patient’s smoking status
under the new CDS protocol in the last 12 months. With only 18 more people being
identified from the previous non-CDS protocol year, that averages out to 1.5 patients per
EHR Go Knowledge Activity: Implementing Clinical Decision Support (Master’s) HMK1015.1
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month having their smoking status identified. This is a very low number of patients.
This is not a significant increase in meeting the CDS goals. Next, in the last year of CDS
protocol goals, 261 people were seen and 239 have not been seen. That is a difference
of 22 more people being seen in the last 12 months. There are only 18 newly
documented smoking status patients in the last twelve months. So right there alone,
more people have been seen but even less have been assessed than before. The known
status for the non-CDS year was 31% compliance. The known status for the CDS year
was 36% compliance. This is only a 5% increase for the whole year. Not a good
improvement. With the goal being 80% compliance level with smoking status
documented, they have not even met ½ of that goal.
9. Based on the report of Central Clinic patients, was the CDS protocol goal for Smoking
Cessation (80% of patients seen in the first year would have a documented smoking
status) met? How can you tell?
No, it was not for the reasons listed in number 8.
10. Based on the report of Central Clinic patients, was the CDS protocol goal for Smoking
Cessation (100% of patients who currently smoke would be encouraged to quit and
provided with smoking cessation literature) met? How can you tell?
No, it was not because there is no documentation in the Central Clinic data that this
criterion was even addressed or quantified. There is no documentation about an
assessment of a patient’s willingness to quit, there are no treatment recommendations,
there are no patient education notes, there is no indication that smoking cessation
literature was given to any patient, and there are no listed or quantified data about any
cessation measures noted.
Th
Open the EHR of Ernesto Cortez, one of the Central Clinic patients seen within the
Smoking Cessation CDS window. Review the EHR, paying special attention to the Notes,
Problems, and Alerts tabs. As you review the EHR, answer the following questions.
sh
EHR Audit Questions
11. Where is Ernesto’s smoking status recorded in the EHR? List all areas.
In the top bar listed as an alert with a red triangle and an exclamation point is a clinical
reminder for smoking cessation as a clinical reminder dated 2/28/2019 at 16:59. In the
EHR Go Knowledge Activity: Implementing Clinical Decision Support (Master’s) HMK1015.1
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Alert Reminder Details, on 2/28/2019 at 16:59, there is an active clinical reminder for
smoking cessation for everyday current smoker – “provided verbal encouragement and
patient smoking cessation brochure. Will provide phone call counseling and check-in
weekly.” This is to be done once per week and the last time it was completed was
2/28/2019 and the reminder is now overdue.
Under Problems and problem details, the smoking status is noted as a current priority,
and that status is active. The description is Z72.0 tobacco use with the immediacy being
chronic. The date of onset is 7/19/1999.
Under the History and Physical Detail and Notes, on 2/28/2019 at 16:44, at Central
Clinic, the notes detail smoking history and habits and in the plan section it is stated
“encouraged to quit smoking and lose weight. Gave patient smoking cessation patient
brochure.”
In the same section for the 2/3/2017 visit at Central Clinic, smoking is
mentioned but only briefly and in nowhere near the detail as it is in 2019. This leads me
to believe that Central Clinic clearly met the CDS protocol goal in relation to Ernesto.
12. Based on Ernesto’s EHR record alone, was the CDS protocol goal to provide patients
who currently smoke encouragement to quit and smoking cessation literature met in
his case? How can you tell?
Yes, in Ernesto’s case alone, the CDS protocol was clearly met as detailed in the specific
areas listed in the answer to number 11.
13. Is the Current every day smoker clinical reminder up to date? How do you know?
No, the Current every day smoker clinical reminder is wonderful, but is states that it is
overdue and late in Ernesto’s case.
Th
14. Are you able to quantify how many patients Central Clinic clinicians encouraged or
the methods that most helped patients to quit smoking from this data? Why or why
not?
sh
No, I cannot quantify how many patients Central Clinic clinician encouraged, or methods
used that most helped patients to quit smoking because there is no data in the pivot
table regarding any of these criteria. Further, you cannot tell from Ernesto’s case
because he is only one patient.
Critical Thinking Questions
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15. The CDS Smoking Cessation protocol calls for every patient’s current smoking status
to be assessed and documented in the EHR. Do you think this protocol was followed
over the last 12 months? Please explain your answer.
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The CDS Smoking Cessation protocol was followed for Ernesto, with the caveat that his
current cessation counselling reminder is overdue. But the pivot table data shows that
only 36% of the patients had their smoking status assessed. There is no indication of
whether any patients who smoke were given encouragement to quit or any smoking
cessation literature.
16. Evaluation of Goal 1: 80% of patients seen in the first year will have a documented
smoking status. Indicate whether this goal was met, not met, or unable to determine
given the current available information. Explain your rationale for the evaluation of
Goal 1.
CDS Smoking Cessation Goal 1 was not met given the current information as only 36% of
the patients seen during the protocol period have a documented smoking status and the
goal was 80%.
17. What are your recommended changes related to meeting Goal 1 next year?
sh
Th
I am combining my answer to 17 and 19 into this answer. To meet goal one and two, a unified
system of protocol and procedure needs to be implemented and then training instituted. The
EHR system should be set to make this question a flag that must be answered early in the entry
of data before any other data can be entered. If this question is not answered, you cannot go
any further. Once this question is answered, then additional screens should open to assess and
complete goal 2. These fields must be completed before the data entry and exam can continue.
Literature should be place in each and every room for easy access to hand to the patient. Signs
should be placed in each and every room explaining to the patient why this is being done and
giving them a contact person for information and pointing them to the cessation literature in
the room. If you have paper records that are later incorporated into the EHR, then every patient
file should have a form placed in the very front of the file to be completed by the clinician and
provider before proceeding any further. This form should have all necessary fields to complete
goal 1 and 2 of the CDS Smoking Cessation protocol. Then the EHR should trigger alerts to
continue counseling and guidance for encouragement of smoking cessation.
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18. Evaluation of Goal 2: 100% of patients who currently smoke would be encouraged to quit
and provided with smoking cessation literature. Indicate whether this goal was met, not
met, or unable to determine given the current available information. Explain your rationale
for the evaluation of Goal 2.
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It cannot be determined if Goal 2 was met as there is no data regarding if anyone was
encouraged to quit or provided with smoking cessation literature in the pivot table. The only
indication we have that this has been done at least once is in Ernesto’s file.
19. What are your recommended changes related to meeting Goal 2 next year? Please see
answer to number 17.
20. The Central Clinic Medical Director would like to implement more CDS protocols this year
and asks for your number one recommendation for success. Based on the data in the report
and the EHR, what is your advice?
sh
Th
Please refer to answer number 17. The main recommendation is having the tools in place that
cannot be ignored or delayed. If a work-around if found and used, then consequences of failing
to comply should be in place.
EHR Go Knowledge Activity: Implementing Clinical Decision Support (Master’s) HMK1015.1
Archetype Innovations LLC ©2019
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