Use Case Table of Contents
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Bilirubin Chart Writes a Transcutaneous Bilirubin Observations
To assess the risk of hyperbilirubinemia in new borns, a clinician uses a transcutaneous bilirubinometer to read the serum bilirubin levels. The clinician then documents the reading to be stored as part of the patients longitudinal record inside the EHR using the Bilirubin Chart Application.
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Clinical Decision Support Scenario
Proposed: Comprehensive scenario demonstrating a multitude of different CDS use cases.
This scenario and its constituent uses cases are being developed by the CDS Collaboratory, a "joint venture" between the OpenCDS, Socratic Grid , and that will soon to include many other , open source communitiesHSPC participants.
"A San Diego VA patient with essential hypertension is traveling in the Phoenix area and is involved in a severe car accident that leaves him severely injured and comatose. He is admitted to a local intensive care unit and is being treated, among other things, with drug XXX for hypertension. His vital signs and arterial blood pressure are displayed on a bedside Phillips CR Monitor. A Clinical Decision Support System (CDSS) monitors the patient's care and advises the clinical staff as they treat the patient for his injuries.
Use Case #1: The system detects that with each XXX administration, the patient experiences a transient, but clinically significant (suboptimal) drop in systemic blood pressure. These dips, however, are still within the Philips Monitor's configured parameters and so no alarm is triggered. Typically, these transient events would be managed by a dose and/or interval adjustment. However, the hospital is a NwHN participant and has access to the patient's VA medical history and genome profile. It determines that the patient is genetically predisposed to unpredictable responses to his XXX medication. After determining alternative therapies, the system checks a drug-allergy knowledge base, evaluates the possibilities in light of the patient's VA allergies, recommends a suitable substitute and generates the corresponding provider recommendation.
Use Case #2: When the provider fails to acknowledge the alert within a mandated period of time, the system escalates the message to the provider's cell phone. Upon receiving an appropriate HIPAA compliant text, the provider logins in, opens the alert, reviews several InfoButton provided references, and ultimately accepts the recommendation. The system then retrieves the corresponding orderable from an Order Catalog and the provider completes and signs the order.
Use Case #3: Later, as the patient is preparing to be discharged, the system prompts the provider to complete a suicide risk assessment as recommended for all former combat veterans. Upon completing the survey, the system passes the information to a Suicide Risk predictive model that determines that the patient is a high risk. The corresponding mental health follow-up appointment is made and the VA provider is notified to ensure appropriate transition of care."
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