Wednesday, July 9, 2008

Clinical Reminders

I've previously written about the importance of Inpatient and Outpatient Decision Support.

Yesterday, I joined an expert panel on Clinical Decision Support, hosted by Dr. David Bates at Partners. Part of this multidisciplinary effort is to review the clinical reminders that institutions have implemented in their electronic health records. The definition of a reminder is that a non-urgent notice appears on the EHR patient summary screen and the clinician's schedule. Reminders are suggestions for clinicians to follow so that best practice guidelines are followed. An alert, by contrast, is an urgent issue which must be escalated immediately. Alerts at BIDMC include such issues as critical lab values or a notice that a patient has been hospitalized. Here are the reminders in use today at BIDMC:

Women 40 and over: yearly

Pap Smear
All women: annually

Influenza Vaccine
Children under 2
Adults 50 and over
Patients with diabetes

Children under 5 (PCV): 3 doses,
alert for each dose when due
Adults 65 and over (PPV): once
Patients with diabetes (PPV): once

Tetanus (Td)
Adults: Every ten years

Prostate Specific Antigen
Men 50 and over: yearly

Adults 50 and over: every 10 years

Bone Mineral Density
Women 65 and over: once

Health Care Proxy
All patients who do not have one on file

For HIV-patients only:
Ophthalmologist, H. Flu Vaccine, PPD, Baseline Labs

I look forward to working with this expert panel and broadly sharing the clinical reminders from all of our institutions.
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