Feasibility of linking external valuation sources to bedside-caregiver activities in interdisciplinary patient care standards.

Establishing accurate and standardized values for bedside-care activities is crucial to the development of resource utilization prediction and management systems. We describe our experience of associating a representative sample of activities extracted from interdisciplinary patient care standards developed at Intermountain Healthcare with an external database of time & motion valued actions. The association exercise revealed important considerations for the development of a standard methodology for linking activities to future national or international standardized value units.

Integration of interdisciplinary guidelines with clinical applications: Current and future scenarios.

Intermountain Healthcare (Intermountain) has developed a referential free-text interdisciplinary document collection to define standards for patient care. In order to improve access and use in bedside clinician workflow, Intermountain converted the document collection into a ubiquitous web-compatible format. The content has been structured using XML so it can be utilized by Intermountain's existing clinical applications, as well as positioning it for use in future deployed applications. It has become evident the strategy of structuring the content in this web-compatible format will support its use to drive current and future system functionality. As Intermountain moves forward in creating and deploying clinical applications, it is important to maintain and improve the current collection structure, sustaining the efficient integration and use of the content necessary to support clinician workflow and to meet information needs.

Linking interdisciplinary patient care standards to clinical information systems using structured actions.

Intermountain Healthcare (Intermountain) has developed and deployed a document collection of over 700 evidence-based inpatient interdisciplinary patient care standards as a means of improving patient care by reducing practice variability. We propose to identify and structure action concepts from these care standards, define their embedded work items and relative financial values, and use the coded concepts as the application development construct that enables patient workload requirement and cost prediction. Valid action concepts will conform to a compositional terminology model that details clinically meaningful information at various levels of granularity as well as the minimum required experience (e.g., licensure) and relative probable effort required for performing the action. The projected total actions that a patient requires will form the basis for workload and cost prediction.

Development of coded action concepts to support workload and cost prediction applications.

We propose to use a compositional terminology model to encode care-directive concepts or "actions" from patient care standards. Action concepts are made up of one or more work items that can be part of a work list or care plan. The nature of an action is specified by the elements of the terminology model. Actions can have implied financial value. The projected total actions that a patient requires will form the basis for workload and cost prediction.

Usability evaluation at the point-of-care: a method to identify user information needs in CPOE applications.

Point of care usability evaluation may help identify information needs that occur during the process of providing care. We describe the process of using usability-specific recording software to record Computerized Physician Order Entry (CPOE) ordering sessions on admitted adult and pediatric patients at two urban tertiary hospitals in the Intermountain Healthcare system of hospitals.