The Culture of Healthcare: Healthcare Processes and Decision Making

The Culture of Healthcare
Healthcare Processes and

Decision Making
Lecture a
This material (Comp2_Unit4a) 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
Making
Learning Objectives
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)

2
Health IT Workforce Curriculum
Version 3.0/Spring 2012
Healthcare Processes and Decision Making
Lecture a
The Classic Paradigm
Classic paradigm assumes a single patient
interacts with a single clinician
Patient has a single problem
Care is provided during a single episode
Various tools mediate this process
Medical records
Computers
Clinical decision support
3
Lecture a
Classic Paradigm
Evolution of tools that support the task
"Central Theorem of Health Informatics"
human + computer > human alone
Classic Paradigm in Health Informatics
one patient
one problem
one clinician
one visit
Technology supports this 1:1:1:1 paradigm

4
Lecture a
Attributes of Clinician
Possesses specialized knowledge
Received experiential training
Has direct relationship with patient and makes
decisions about patient care
Acts in patients best interest
Integrates diverse types of information
Functions within time & resource constraints

5
Lecture a
Types of information
Patient Data refers to one person
patient, family,
records, observation
Population Statistics
aggregated patient
data
colleagues, public
health dept, EHR
Medical Knowledge
generalizable to many
persons
textbooks, journal
articles, MEDLINE
Logistic Information
how to get things
done
people, policy and
procedure
Social Influence
how others get the job
done
observe and discuss
with colleagues
4.1 Table: Types of information that clinicians utilize when making decisions
6
Lecture a
Organization
How clinicians organize information?
Narrative structure
Rearranged into a history and physical format
Further rearranged into a hierarchy
Reformulated into a computable structure for
utilization by clinical information systems
7
Lecture a

Disease hides its secrets in a
casual parenthesis
(Tumulty, Philip A., nd.)
8
Lecture a
How stories fit into health system
Part 1
Communication between patient and clinician
Facts embedded in story (meaning to
clinician)
Meaning of the illness to the patient
Communication and relationship building
Therapeutic value
Important aspect of quality of care

9
Lecture a
How stories fit into health system
Part 2
Among Clinicians
Efficient communication among experts
Values and ethics are communicated through
stories
How do modern healthcare systems (and HIT)
affect stories?
Eliminate or alter them
Lose context
10
Lecture a
Interpretation
How clinicians understand clinical data
Disciplinary differences
Different approaches to clinical data
interpretation
Development of social construction
Contextual interpretation of data

11
Lecture a
12
Beyond the Classic Paradigm
Collaboration in Surgery
Multiple disciplines with different roles and tasks
Short time horizon
Requires advance planning, resource rich
4.2 Table: Comparison of the classic paradigm with the operating room.
Patients problems clinicians visits
classic
paradigm
1 1 1 1
operating
room
1 1 many 1
Lecture a
13
Uncertain, complex, high stakes
Complex acute illness - multiple disciplines, roles,
tasks
Short time horizon, unplanned events, uncertain
data
4.3 Table: Comparison of the classic paradigm with the operating room and acute complex illness.

Lecture a
patients problems clinicians visits
classic
paradigm
1 1 1 1
operating room
1 1 many 1
acute complex
illness
1 many many 1 or more
14
Uncertain, complex, high stakes
Simultaneous care of multiple acute and non-acute - very short time
horizon
Planning for the unexpected, resources are often constrained
Coordination, cooperation, collaboration
4.4 Table: Comparison of the classic paradigm with the operating room, acute complex illness and emergency dept.

Lecture a
patients problems clinicians visits
classic
paradigm
1 1 1 1
operating room 1 1 many 1
acute complex
illness
1 many many 1 or more
Emergency dept many many many 1
15
Steps in the Classic Process
What is the matter?
diagnosis
What can be done?
treatment
What will happen?
prognosis
Gathering data
Analyzing findings
Making a diagnosis
Choosing treatment
Communicating the
plan

Lecture a
Healthcare Process and Decision Making
Summary Lecture a
Looked at types of information that clinicians use
in the course of managing patients
Defined the role and nature of a clinician
Examined the classic paradigm of the clinical
process and also looked at some alternate
paradigms

16
Lecture a
Healthcare Processes and
Decision Making
References Lecture a
References

Evans, DA and Patel, V. (1989) Cognitive Science in Medicine: Biomedical modeling. MIT Press, Cambridge, MA
Retrieved from http://portal.acm.org/citation.cfm?id=575722
Friedman, CP. (2009). A Fundamental theorem of biomedical informatics. Journal of the American Medical
Informatics . Retrieved from http://jamia.bmj.com/content/16/2/169.short
Gorman, PN. (1995) Information needs of physicians. Journal of the American Society for Information Science
and Technology
Hunter, KM. Doctors' (1991) stories: The narrative structure of medical knowledge. Princeton University Press
(1991)
Kassirer, P and Kopelman, I. Learning clinical reasoning . pp. 332.
Tumulty, Philip A., (nd.) Quotation. Disease hides its secrets in a casual parenthesis
17
Lecture a
Charts, Tables, References

4.1 Table: Types of information that clinicians utilize when making decisions
4.2 Table: Comparison of the classic paradigm with the operating room.
4.3 Table: Comparison of the classic paradigm with the operating room and acute complex illness.
4.4 Table: Comparison of the classic paradigm with the operating room, acute complex illness and emergency
dept.

The Culture of Healthcare: Healthcare Processes and Decision Making

Uploaded by

Document Information

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

The Culture of Healthcare: Healthcare Processes and Decision Making

Uploaded by

Copyright:

Available Formats

The Culture of Healthcare

Healthcare Processes and

You might also like