Incorporating INTERACT II Clinical Decision Support Tools into Nursing Home Health Information Technology: Page 2 of 3

November 10, 2011

INTERACT II Tools That Lend Themselves to NH HIT Integration

Based on previous experience and feedback from sites participating in INTERACT projects, five CDS tools should be considered for integration into NH HIT:

1. Stop and Watch: This tool can be used by certified nurse
assistants (CNAs) to note observed acute changes in resident condition and to document these changes. It also provides guidance on reporting these changes to a nurse or nurse practitioner for further evaluation and management.

2. Care Paths: These tools enable nursing staff to assess residents who have common conditions that may result in a potential transfer to a hospital and notify the appropriate primary care provider regarding a resident’s condition.

3. Situation, Background, Assessment, Recommendation (SBAR): This structured communication framework and progress note enables nursing staff to document and facilitate communication with primary care providers about their assessments based on the Care Paths and other tools.

4. Resident Transfer Form: This form is to be completed by nursing staff to ensure that a standardized set of resident-specific data accompany all transfers to the emergency department.

5. Quality Improvement Review: This tool is used to examine transfer situations and provide opportunities to discuss interventions that may have resulted in a different outcome.

Lessons Learned From Others’ CDS Design and Implementation

Several key experiences from previous efforts to design and implement CDS tools provide guidelines to automate existing paper tools, offering insights into the design process, quality and timeliness of information, ease of use, presentation of information, and integration into clinical workflow.7-15 Lessons from these experiences are outlined in detail in the Table [click thumbnail for full view]. Before proceeding to integrate INTERACT II tools into NH HIT systems, these lessons should be carefully considered to ensure success.

Roadmap for Integrating INTERACT II Paper Tools Into NH HIT

Several major design steps are required when translating paper-based INTERACT II tools for use in HIT. These steps include establishing goals of the CDS design phase, assembling an integrated team, confirming data elements, translating clinical decision tools from paper to HIT, integrating CDS into the workflow, and pilot testing the tools before implementation.

Establishing CDS Design Phase Goals

The result of the design phase will be software requirements for HIT software developers. The software requirements specification document will describe the seamless integration of best practice guidelines into caregiver day-to-day workflow, communications, and documentation. It will also specify requirements of CDS. The goals of integrating INTERACT II CDS tools into NH HIT software include:

• Facilitating earlier identification of residents at risk for
hospitalization or rehospitalization.

• Ensuring timelier follow-up on recommended care path interventions for residents identified as being at risk for acute care transfer.

• Delivering workflow efficiencies by autogenerating forms and communication tools prefilled with previously recorded resident information, such as resident name, identification, diagnosis codes, allergies, vital signs, and medications.

•  Supporting quality improvement efforts by providing summarized information in the form of reports to understand root cause patterns and trends.