Knowledge Activity: Implementing Clinical

Decision Support (Baccalaureate)

Student instructions
1. If you have questions about this activity, please contact your instructor for assistance.
2. You will review the chart of Ernesto Cortez to complete this activity. Your instructor has
provided you with a link to the Implementing Clinical Decision Support (BS) activity.
Click on 2: Launch EHR to review the patient chart and begin this activity.
3. Refer to the patient chart and any suggested resources to complete this activity.
4. Document your answers directly on this activity document as you complete the activity.
When you are finished, you will save this activity document to your device and upload
this activity document with your answers to your Learning Management System (LMS).

Glossary
Clinical Decision Support: (CDS) is defined as a process for enhancing health-related decisions
and actions with pertinent clinical knowledge and patient information to improve healthcare
delivery. In the EHR clinical decision support includes alerts, reminders and documentation
templates aimed to improve clinical processes and outcomes. For the purposes of Meaningful
Use clinical decision support builds upon the foundation of an EHR to provide healthcare
providers with information to enhance health and health care. (Health IT.Gov, 2016)

The activity
The clinic where you work implemented a Clinical Decision Support (CDS) protocol one year
ago. The CDS protocol was smoking cessation. The providers and staff were instructed to follow
the protocol based on the CDS Start Kit: Smoking Cessation. The goals for implementation were,
1) 80% of patients seen in the first year would have a documented smoking status and, 2) 100%
of patients who currently smoke would be encouraged to quit and provided with smoking
cessation literature.

Most clinicians feel they did a good job of assessing smoking status and encouraging patients to
quit. The Clinic administration would like to see whether the CDS Smoking Cessation protocol

EHR Go Knowledge Activity: Implementing Clinical Decision Support (Baccalaureate) HBK1015.2 1

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goals were met this year. You need to analyze the data from the first year of Smoking Cessation
CDS. You ran a report on 500 clinic patients looking for a smoking status documented in the
problem list.

Access the report (an Excel spreadsheet included with this activity under 1: Overview
and Resources) and follow the instructions below to create a Pivot Table using that
Excel spreadsheet.

Pivot table instructions:

a. In the spreadsheet, select and highlight all the cells that include data.
b. Then select Insert>Pivot Table
c. Leave the default selections as they are (defaults are: “Select a table or
range”/ 'Problem List’ and New Worksheet). Press OK.
d. On the right-hand side of the pivot table screen, click and drag the “Smoking
Status assessed in last 12 months” check box into the Columns box.
e. Then click and drag the “Current Smoking Status” check box into the Rows
box.
f. Finally, click and drag the “Smoking Status assessed in last 12 months” into
the Values box.

Examine the resulting pivot table and answer the following questions.

Questions
*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?

2. What percentage of patients in the report population were not seen in the Central
Clinic within the last 12 months?

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?

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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?

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?

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?

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?

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.

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?

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?

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.

EHR Audit Questions

11. Where is Ernesto’s smoking status recorded in the EHR? List all areas.

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?

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13. Is the Current every day smoker clinical reminder up to date? How do you know?

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?

Critical Thinking Questions

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.

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.

17. What are your recommended changes related to meeting Goal 1 next year?

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.

19. What are your recommended changes related to meeting Goal 2 next year?

Submit your work

Document your answers directly on this activity document as you complete the activity. When
you are finished, save this activity document to your device and upload this activity document
with your answers to your Learning Management System (LMS). If you have any questions
about submitting your work to your LMS, please contact your instructor.

Learning objectives
1. Analyze strategies for the management of information (4)
2. Evaluate data dictionaries & data sets for compliance with governance standards (5)

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 3. Examine health care findings with data visualizations (4)
4. Leverage data-driven performance improvement techniques for decision making (5)
5. Facilitate training needs for a healthcare organization (4)

References
CDS Starter Kit: Smoking Cessation. Retrieved March 2, 2014 from
http://www.healthit.gov/policy-researchers-implementers/cds-implementation

HealthIT.gov. Clinical Decision Support (CDS). Retrieved March 2, 2014 from

http://www.healthit.gov/

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