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The Culture of Healthcare
Healthcare Processes and Decision Making
Lecture e
This material (Comp2_Unit4e was developed by Oregon Health & Science University, funded by the Department of Health and Human Services, Office of the National Coordinator for Health Information Technology under Award Number
IU24OC000015.
Healthcare Processes and Decision MakingLearning Objectives
2
• Describe the elements of the 'classic paradigm' of the clinical process (lecture a).
• List the types of information used by clinicians when they care for patients (lecture a).
• Describe the steps required to manage information during the patient-clinician interaction (lecture a,b,c).
• List the different information structures or formats used to organize clinical information (lecture b).
• Explain what is meant by the 'hypothetico-deductive' reasoning process (lecture a,b).
• Explain the difference between observations, findings, syndromes, and diseases (lecture a,b,c).
• Describe techniques or approaches used by clinicians to reach a diagnosis (lecture a,b,c,d,e).
• List the major types of factors that clinicians consider when devising a management plan for a patient's condition, in addition to the diagnosis and recommended treatment (lecture e).
Health IT Workforce Curriculum Version 3.0/Spring 2012
The Culture of Healthcare Healthcare Processes and Decision Making
Lecture e
Keeping Track Of Care
“never ask a new patient a question without note-
book and pencil in hand...
Sir William Osler (1849 - 1919)
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The Culture of Healthcare Healthcare Processes and Decision Making
Lecture e
(Corner, 1905. PD-US)
Problem ListBuilding Relationship, Negotiating
Plans
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• Diabetes– Polyuria, polydipsia, polyphagia– hyperglycemia
• HTN– high BP x 3– EKG shows left ventricular hypertrophy
• Hyperlipidemia– LDL 194– Triglycerides 250
• Body Mass Index 34
The Culture of Healthcare Healthcare Processes and Decision Making
Lecture e
Who is the Audience?What is the message for each?
• Patient• Family, Friends, the
Public• Clinical staff – nurses,
lab, x-ray, therapists, pharmacists, dietician
• Yourself – now and later
• Colleagues
• Consultants• Insurance companies• Lawyers (plaintiff and
defendant)• Compliance officers,
regulators• Researchers, data
miners• Performance
measures5Health IT Workforce Curriculum
Version 3.0/Spring 2012
The Culture of Healthcare Healthcare Processes and Decision Making
Lecture e
Communicating with Patient
• Patient education – what’s wrong
• Instructions – what to do
• Reassurance – what will happen
• Motivation, hope
• Acknowledgement, acceptance
• “I’ll be there for you”
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The Culture of Healthcare Healthcare Processes and Decision Making
Lecture e
Family, Friends, the Public
• What do they need to know?
• What will be best for the patient?
• What will be best for the family member?
• What can I legally tell?
• What can I ethically tell?
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The Culture of Healthcare Healthcare Processes and Decision Making
Lecture e
Clinical Staff
• Nurses
• Pharmacist
• Dietician
• Therapists: physical, occupational, respiratory, massage, acupuncture
• Lab
• X-ray
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The Culture of Healthcare Healthcare Processes and Decision Making
Lecture e
Oneself
• “Nothing clears up a case so much as stating it to another person” (Sherlock Holmes, 1893)
• Processing effect of recording case
• Effect of structure and order
• Impact of recording technology
• Prospective memory – notes to myself, a la “Memento”
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The Culture of Healthcare Healthcare Processes and Decision Making
Lecture e
Other CliniciansColleagues• Future responsibility for
patient• Format• Content• Detail• “Experts share knowledge
not only of their domain, but of the structure and goals of their discourse” (Evans, 1989)
Consultants• Ask a clear question – get
a much better answer• What to share – what to
leave out– Neurologist– Psychiatrist– Cardiologist– Radiologist
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The Culture of Healthcare Healthcare Processes and Decision Making
Lecture e
Insurance companies
• Documentation of the illness– ICD9
• Documentation of the procedure– CPT4
• Documentation of the process– Details to support the diagnosis and treatment
plan
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The Culture of Healthcare Healthcare Processes and Decision Making
Lecture e
How much detailIn what form?
• Lawyers
• Regulatory agencies
• Data mining
• Clinical and Outcomes research
• Quality and Performance improvement
• Patient Safety
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The Culture of Healthcare Healthcare Processes and Decision Making
Lecture e
Healthcare Processes and Decision Making
Summary – Lecture eThis lecture examined:
• How clinicians gather patient data• How they analyze it and utilize distinct
techniques to reach a diagnosis and formulate a plan
• How clinicians communicate their plan with the patient and others who need information.
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The Culture of Healthcare Healthcare Processes and Decision Making
Lecture e
Healthcare Processes and Decision Making
SummaryThis unit examined the process of diagnosis and determination of a care plan:•Role and nature of a clinician; classic and alternate paradigms•Information gathering, process, analysis•Diagnostic thinking and techniques•Models used to choose therapy and formulate a management plan•Communication of the management plan
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The Culture of Healthcare Healthcare Processes and Decision Making
Lecture e
Healthcare Processes and Decision Making
References – Lecture e
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References• Conan Doyle A. Silver Blaze. The Memoirs of Sherlock Holmes (1893)• Evans, D. A., & Gadd, C. S. (1989). Managing coherence and context in medical problem solving discourse. In D.
A. Evans & V. L. Patel (Eds.), Cognitive science in medicine: Biomedical modeling (p. 214). Cambridge, MA: MIT Press.
• Feldman M, Christensen J. Behavioral Medicine: A Guide for Clinical Practice, Third Edition. McGraw-Hill Medical; 3 edition (2007)
• Ley P. Communicating with patients: Improving communication, satisfaction and compliance. Psychology and medicine series. New York, NY, US: Croom Helm. (1988)
Images• Slide 3: Corner, T. C. (1905). http://commons.wikimedia.org/wiki/File:Sir_William_Osler.jpg. Retrieved November
2011, from Wikimedia Commons website: http://commons.wikimedia.org. Public domain image (PD-US).
The Culture of Healthcare Healthcare Processes and Decision Making
Lecture e