Computable Guidelines and Clinical Decision Support for Cervical Cancer Screening and Management to Improve Outcomes and Health Equity.

Cervical cancer is highly preventable when precancerous lesions are detected early and appropriately managed. However, the complexity of and frequent updates to existing evidence-based clinical guidelines make it challenging for clinicians to stay abreast of the latest recommendations. In addition, limited availability and accessibility to information technology (IT) decision supports make it difficult for groups who are medically underserved to receive screening or receive the appropriate follow-up care. The Centers for Disease Control and Prevention (CDC), Division of Cancer Prevention and Control (DCPC), is leading a multiyear initiative to develop computer-interpretable ("computable") version of already existing evidence-based guidelines to support clinician awareness and adoption of the most up-to-date cervical cancer screening and management guidelines. DCPC is collaborating with the MITRE Corporation, leading scientists from the National Cancer Institute, and other CDC subject matter experts to translate existing narrative guidelines into computable format and develop clinical decision support tools for integration into health IT systems such as electronic health records with the ultimate goal of improving patient outcomes and decreasing disparities in cervical cancer outcomes among populations that are medically underserved. This initiative meets the challenges and opportunities highlighted by the President's Cancer Panel and the President's Cancer Moonshot 2.0 to nearly eliminate cervical cancer.

Family Caregiving for Individuals With Heart Failure: A Scientific Statement From the American Heart Association.

Many individuals living with heart failure (HF) rely on unpaid support from their partners, family members, friends, or neighbors as caregivers to help manage their chronic disease. Given the advancements in treatments and devices for patients with HF, caregiving responsibilities have expanded in recent decades to include more intensive care for increasingly precarious patients with HF-tasks that would previously have been undertaken by healthcare professionals in clinical settings. The specific tasks of caregivers of patients with HF vary widely based on the patient's symptoms and comorbidities, the relationship between patient and caregiver, and the complexity of the treatment regimen. Effects of caregiving on the caregiver and patient range from physical and psychological to financial. Therefore, it is critically important to understand the needs of caregivers to support the increasingly complex medical care they provide to patients living with HF. This scientific statement synthesizes the evidence pertaining to caregiving of adult individuals with HF in order to (1) characterize the HF caregiving role and how it changes with illness trajectory; (2) describe the financial, health, and well-being implications of caregiving in HF; (3) evaluate HF caregiving interventions to support caregiver and patient outcomes; (4) summarize existing policies and resources that support HF caregivers; and (5) identify knowledge gaps and future directions for providers, investigators, health systems, and policymakers.

To Share is Human! Advancing Evidence into Practice through a National Repository of Interoperable Clinical Decision Support.

BACKGROUND: Healthcare systems devote substantial resources to the development of clinical decision support (CDS) largely independently. The process of translating evidence-based practice into useful and effective CDS may be more efficient and less duplicative if healthcare systems shared knowledge about the translation, including workflow considerations, key assumptions made during the translation process, and technical details. OBJECTIVE: Describe how a national repository of CDS can serve as a public resource for healthcare systems, academic researchers, and informaticists seeking to share and reuse CDS knowledge resources or "artifacts." METHODS: In 2016, the Agency for Healthcare Research and Quality (AHRQ) launched CDS Connect as a public, web-based platform for authoring and sharing CDS knowledge artifacts. Researchers evaluated early use and impact of the platform by collecting user experiences of AHRQ-sponsored and community-led dissemination efforts and through quantitative/qualitative analysis of site metrics. Efforts are ongoing to quantify efficiencies gained by healthcare systems that leverage shared, interoperable CDS artifacts rather than developing similar CDS de novo and in isolation. RESULTS: Federal agencies, academic institutions, and others have contributed over 50 entries to CDS Connect for sharing and dissemination. Analysis indicates shareable CDS resources reduce team sizes and the number of tasks and time required to design, develop, and deploy CDS. However, the platform needs further optimization to address sociotechnical challenges. Benefits of sharing include inspiring others to undertake similar CDS projects, identifying external collaborators, and improving CDS artifacts as a result of feedback. Organizations are adapting content available through the platform for continued research, innovation, and local implementations. CONCLUSION: CDS Connect has provided a functional platform where CDS developers are actively sharing their work. CDS sharing may lead to improved implementation efficiency through numerous pathways, and further research is ongoing to quantify efficiencies gained.

Streamlining regulatory compliance through clinical systems.

The Joint Commission states that its mission is "to continuously improve the safety and quality of care provided to the public through the provision of healthcare accreditation and related services that support performance improvement in healthcare organizations.... Accreditation is a risk-reduction activity; compliance with standards is intended to reduce the risk of adverse outcomes" (JCAHO, 2003). The focus of JCAHO is not much different from that of every health care organization. Clinical information systems should be employed to help deliver safer, more efficient patient care, and at the same time ensure that health care organizations achieve regulatory compliance.

Implementing clinical IT in critical care: keys to success.

Ensuring the success of a clinical information system in critical care requires careful selection of the right system to address the unique needs in this area. In addition, the methodology used for implementation must include key stakeholders, ensure nursing and physician leadership, understand and improve clinical processes, and provide ongoing training and support. These guidelines can be applied to the implementation of any clinical information system. They provide the opportunity to demonstrate value and benefits from CIS in critical care and beyond.

Improving the patient experience with information technology.

It has been proven in many different studies that information technology solutions can improve information transfer, workflow, and communication, resulting in marked improvements in patient safety and overall quality of care. However, equally important but not often emphasized is the potential for information technology to improve the patient experience by making a positive impact on the care that matters most to patients and their families.

Computerized physician order entry: a prescription for patient safety.

Clinician adoption of CPOE/CDS solutions is crucial to helping caregivers reduce medical errors and enhance patient safety. The LeapFrog Group CPOE/CDS report can be a helpful guide, but as clinicians concerned about the quality of health care and the well-being of our patients, we must play an active role in the successful adoption of these solutions by: 1. Making sure that your institution is committed to having the appropriate people involved in the entire process, including nurse leaders. 2. Selecting a vendor that has the knowledge and clearly understands the importance of implementing this type of system. 3. Ensuring that your organization is selecting a system that actually meets the criteria defined by the LeapFrog Group.

The nursing shortage: can information technology help?

There is no doubt that the nursing shortage is a real and valid concern for the medical community. American Hospital Association President Dick Davidson reports: "America needs up to 126,000 nurses now, as well as more pharmacists, lab technicians, support staff and others. We need immediate action to help alleviate this situation" (American Hospital Association, 2001). Clinical information systems can be one of those immediate actions that can help nurses feel more confident about the care they are delivering. In addition to preventing medical errors, streamlining workflow and communications, and reducing redundant data entry, these systems can have a lasting and positive effect on overall job satisfaction, providing a significant influence on retaining our invaluable nursing resources.

Nursing informatics: an evolving specialty.

Health care organizations will continue to invest heavily in clinical information systems to help improve patient safety, reduce variability of care, and increase the efficiency of their staff. These clinical information systems can assist in reducing medication errors through sophisticated medication management solutions and provide clinical decision support to aid in the decision making of all clinicians. They can also help offset the effects of a growing worker shortage, especially hard-felt in nursing, by reducing redundant tasks, improving communication, and streamlining clinical data collection. As these clinical systems are implemented, there is an increased need for information management of all of this complex data. By bringing both clinical and information systems expertise to bear, the informatics nurse plays a crucial role in ensuring that these goals are met to help the organization maximize its use of clinical information technology.$