For these reasons there’s the need for Clinical decision support system (CDSS) to support the physicians in making right clinical decisions. Defining Clinical decision support system (CDSS) Clinical decision support system (CDSS) provides clinicians, staff, patients or other individuals with knowledge and person-specific information, intelligently filtered or presented at appropriate times, to enhance health and health care. [1] CDSS encompasses a variety of tools to enhance decision-making in the clinical workflow. These tools include computerized alerts and reminders to care providers and patients; clinical guidelines; condition-specific order sets; focused patient data reports and summaries; documentation templates; diagnostic support, and contextually relevant reference information, among other tools. This paper will discuss the need for CDSS in the health sector particularly on clinical tasks.
SPC Kimberly West SGT Monika Woodard The Importance of the Proper Documentation of Biological’s in the Sterilization Department A question that often comes up in discussions about record keeping is “What type of documentation do we need to keep for our steam sterilization process, and how should information be recorded?” It is important to know not only what to document, but also the purpose for retaining pertinent information. Record keeping or documenting the biologicals is an essential component of an effective sterile processing department’s quality assurance program. Whether the sterilization process is being done in a hospital’s SPD or Operating Room, essential information needs to be documented. Documentation, also commonly referred to as record keeping, documents materials that have been processed and the results of the sterilization process monitoring. While this might sound easy, proper documentation requires diligence by everyone involved as this data provides critical information for tracking processed instruments to the patient and assessing the reliability of the sterilization process.
I noticed that these documents are highly important to performing medical tasks and procedures that allow patients to feel comfortable and in the blood transfusion case, to live. There was similarities and differences between the two documents that made the understanding of medical research so complex and distinct. The rhetorical analysis between the two can be valued as mostly similar, with the context of them to be
What information should be protected, How to deter security as well as how to keep this organization patient’s records safe. By having this knowledge one is already securing the organizations patient’s records. There are a number of threats that affects organizations electronic medical records. These threats come from both internal and external and from both those with malicious and maligned intent. Meaning the potential exists that something needs to be done.
Its Primary purpose is to ensure quality patient care and managing the cost of that care. Its secondary purpose as defined by the Institute of Medicine (IOM) deals with individual users for education, regulations, policies and public health from data entered, verified, corrected or analyzed directly or indirectly. Homeland Security has recently been added to the list of users, including patient care providers, managers and staff, coders and patients themselves. Patients can make changes as necessary. Other users might include lawyers, employers, law enforcement and researchers.
Organization of Medical Symbols and Abbreviations Medical abbreviations and symbols are commonly encountered in hospital and medical offices. They are a quick way of recording information about a patient and giving instructions. Common abbreviations come from Latin phrases. There are many advantages as well as disadvantages of using medical symbols and abbreviations The medical profession has a large number of abbreviations and symbols for everything from medicines to commonly used patient information and phrases. These abbreviations certainly save time and can expedite care, but they can also cause a multitude of problems.
Not only is it important for healthcare providers to construct and implement a treatment plans, but also to involve patients in medical decision making about their treatment. To determine effectiveness, healthcare providers must assess how treatment of the illness effects the patient in addition to their own evaluation of treatment. The dictionary definitions of effective are (a) adequate to accomplish a purpose, producing the intended or expected result; (b) in operation or in force, functioning; (c) producing a deep or vivid impression; (d) prepared and available for service; and (e) a member of the armed forces fit for duty or active service (“Effective”, n.d. a). According to Stedman’s Medical Dictionary (2006), the medical definitions of effective are (a) the extent to which a treatment achieves its intended purpose; (b) A measure of the accuracy or success of a diagnostic or therapeutic technique when carried out in an average clinical environment. According to Wikipedia (n.d. b), the usage of effective includes (a) mathematics, can be used as a synonym of
EHRs are designed to reach out beyond the health organization that originally collects and compiles the information. They are built to share information with other health care providers, such as laboratories and specialists, so they contain information from all the clinicians involved in the patient’s care. EHR data “can be created, managed, and consulted by authorized clinicians and staff across more than one healthcare organization.” The information moves with the patient—to the specialist, the hospital, the nursing home, the next state or even across the country. In comparing the differences between record types, “The EHR represents the ability to easily share medical information among stakeholders and to have a patient’s information follow him or her through the various modalities of care engaged by that individual.” EHRs are designed to be
Project 1 There are many confidentiality, privacy and security issues that relate to working as a medical receptionist in a medical practice. It is very important to have a senior person to oversee all administrative functions. A senior person will outline the tasks your job entails and will teach you the practice’s policies and procedures. They will teach you how to access patient records and how to know what information is relevant to your work. A senior person will also check your work and will be there for guidance if any conflict of interest occurs.
However, Knowles acknowledges that medical professionals play a role with regards to helping people take responsibility for their healthcare. He suggests that preventative healthcare is the key to solving many of today’s health issues. Nonetheless, to promote preventative care, the role that doctors play must be emphasized. He states, “Carrying out such a strategy involves many variables-convincing the doctor to play his pivotal role…” (Knowles 66). Here he is demonstrating the important role that doctors play in healthcare.