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The Five Rights of
Effective Clinical Informatics
Implementation
Right Presentation
Designers
of airplane cockpits have known for years that the way in which information is
displayed can have a huge impact on how quickly and accurately pilots
can understand the significance of the data. The same issues apply in
medicine. Even careful caregivers can misinterpret or fail to recognize
clinically important patterns in the data, especially when they are fatigued or rushed.
Timing
The
most basic issue is whether the data is available to the caregiver at
the Right Time. If the lab has run
the test, but the results are not available when clinical decisions are
made, then the expense has been incurred without benefit to the patient.
In addition, in the event that an adverse
event were to occur, legal culpability might be greater as the chart
would, in retrospect, document the error.
Format
The
data also needs to be presented in the Right Way. Current clinical
events should be interpreted in the context of the patient's prior
medical history--which should be immediately available to the caregiver
as decisions are being made.
Show longitudinal
data...
When
patients have multiple encounters with the healthcare system, the data
from one encounter can color interpretation of subsequent events. As
much as possible, old and new data should be displayed
contiguously--immediately demonstrating that data from a prior event is
available and making recognition of the trend--rising, falling, or
stable--obvious.
Show data in context...
Few
data elements are appropriately interpreted without the context of other
observations. E.g. the impact of a dose of diuretic can't be understood
without knowing the urine volume and net fluid balance that followed
administration of the medication. Thus, it is essential that disparate
data elements be brought together and displayed so that the patterns are
easier to discern
With effective data display, consider ways that rules can assist
caregivers to make the
Right Clinical Decisions. |