Informatics and Evidence Based Practice


You are consulting with the education and practice development team in a large tertiary care hospital serving a region comprising mostly rural communities. The team is responsible for strengthening the implementation of evidence-based practice based on outcomes. Over the next 2 years, it must set performance objectives to (1) strengthen screening for pain, depression, and adverse health behaviors (smoking, excess alcohol intake, and body mass index [BMI] greater than 30) at intake for all adult admissions; (2) implement comprehensive geriatric assessment for all those over age 65 hospitalized for more than 7 days or readmitted within less than 3 days following discharge; and (3) promote care team performance.

The hospital has 200 adult admissions each week and has implemented a fully electronic health record. Guideline dissemination generally occurs through educational venues or via the electronic policy and procedure manual. The method of documentation for narrative notes is documentation by exception using SOAP (subjective, objective, assessment, and plan) and the hospital has also made extensive use of checklists to complement the documentation system.
Discussion Questions

1. Using clinical guidelines and standards of care, identify what data elements should be included in the EHR assessment and evaluation screens if these goals are to be achieved.
2. Identify how information system defaults and alerts could be used to achieve these goals.
3. Once screening has been improved, what are the next steps in improving patient outcomes?
4. How could the EHR be designed to support these outcome-related goals?