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Hello everybody. Today we will be discussing the topics involved are included in the mindmapping and Clinical Decision Support Systems. Module eight. I will provide you with some tips and points that will be useful for the assignment or let’s say discussion. In addition to an overall review related to the midterm. So in my opinion, the midterm went well. Many of you participated and received good grades. Obviously, we had the minimum, we had the maximum. I hope that everyone was able to access all the contents prior to the midterm. Obviously, this will give you a clear understanding related to the style of the questions. The questions again, there’s no external source. Everything will be from the course contents. But as you also saw an experienced, it is imperative to prepare for the midterm and final beforehand. So I’m letting you know right now the finalists. A test or an assessment activity that could include questions from the entire course content. However, the focus will be on contents. Material posted after the midterm. That will tell you right now when you’re preparing for your module. As I told you, this is an advanced course, is not a course to open it on a Sunday afternoon, complete the assignment and hope to get an a. That’s not the style of this course. As you are preparing for the module content during the week, which is basically at least three times logging in. Take notes, discuss even by herself. The contents. See, how can you turn a concept into a question? What type of question could it concept generate? And I will try to give you questions as we proceed through the material in each one of these videos. With that purpose in my mind that I’m encouraging you to do the same when you are preparing for the contents, which is basically develop or generate questions that will allow you to assess your understanding. As always, you have questions, if you have questions, if you have even comments, reach out. I thought I made it clear even previously with my announcements, I always encourage students to reach out. But reach out. And we can either address the questions by e-mail or we can definitely utilize resources such as Zoom Teams. Any type of tool that you are angry, provides us to schedule one of these virtual sessions. That will be obviously a synchronous session. So mind-mapping and decision-making. A lot of these contents, as you can see, we’ll build on top of the initial topics that we started working with in decision support systems. The idea is once you complete a course such as this one and, or courses that will come after, you have that understanding, you have that skill that you can provide. Proper guidance on both the clinical side, on side of the developer that assist them to implement, to design, to work with, and gain maximum benefit from a clinical decision support system. Show in your role. You have to, or you must, or we must. I should say all of us informaticians, ear house care informaticians. We must have a full understanding of what is it really that we are trying to do through these systems? And what are we trying? Who are we trying to serve? What are we trying to provide them? In what area are we trying to serve them? Who are our audience and specific? Visualization models and diagrams are essential muscle communication. All of us have heard, as a picture, says, 1,000 words or is equal to 1,000 words or something like that. Absolutely. But it all comes down to what type of depiction is that picture or graph providing to the user or reader? It has to be wallets, comprehensive, not to be cluttered. While comprehensive, not only focused on one area and missing others, if it had promised to give a full picture, so on and so forth. These models have been also developed to visualize the humans thinking. Mind-mapping is one approach that assisted in organizing the human thought processes. So we are focusing on that area, okay, we’re going to see through these concepts here in the module, how mind-mapping is used and what do we mean by that? It’s a tool basically that is used for decision-making. And what it’s focuses on is prioritizing the problems and identifying gaps. So when you are trying to, let’s even say you’re working with data in a database. A lot of times I’ve had before, even the students reach out and say, who will tell me what performance I’m trying to measure. So interestingly, as a data informatician, you will be hopefully at some point, the person who will see what type of indicators they are even interested in. How you will see that by following the flow of the tasks in your organization, in your team, in your project. Okay? So in many cases you will say, okay, maybe these types of benchmarks that are national are very useful to us. Or maybe these types of benchmarks that are regional, or they involve my state, or they involve hospitals that are of my size are interesting to me. Okay. So same deal when you’re doing mindmapping, you will be focused on what type of shortcomings is it that we’re trying to solve? What type of issues, what type of gaps are we trying to address? So it’s used to plan treatment options, determined diagnostic options, assigned best resources for issues identified. So when we speak of decision support systems, and I’ve noticed in the assignments or in the assessment activity is not very broad perspective is provided. We have to have this broad perspective when we’re talking. Let’s fix our clinical decision support system. In what area? In the area of determining diagnostic options? In the area of planning treatment options, how is that? E.g. if I am working in a hospital and a decision support system has been offered to the hospital with a great price for some reason. I don’t know if the vendor is new to State and they want to get clients, great. Or it’s a small vendors just trying to reach out to bigger hospitals. So it’s a great price diasporas interested. And you’ve been tasked with that duty, with that responsibility to check and see if it’s a good match. And this decision support system basically plans treatment option or plans treatment options. So when you come down to it, you see that basically it’s instructions. It develops or helps nurses or discharge clinicians because they charge collision might be a PA, physician assistant to develop, to generate, to create a treatment option. But when you look at it, you see that the level that they designed this content, let’s say the person who designed it for this vendor was an MD themselves. So it was a physician, right? The level that they designed it, it seems that it requires the knowledge of a physician is beyond the knowledge of a nurse practitioner. Or it requires the constant involvement of an MD to prescribe certain orders or drugs or whatever the case might be. But that’s not the case in your hospital, your hospital. 99% of the time people who are discharging or not MD’s nurses. So right there that will tell you that that system as is, will not work for you either. They need to create a feature within their system to provide the nurse with an immediate Access to a physician whenever they need. So as you are developing the treatment plan, the treatment plans through the system says to you, click here to order ten physical therapy sessions. Right there there should be a button. Contact attending physician contact, attending surgeon contact. I don’t know. Md on duty in the department, whoever the case, whoever the MD is as responsible that can send that order with a button the nurse can contact them, doesn’t have to run around, find MD screenshot of what type of order she wants or he wants to know. That button will do all that that button will send to the physician exactly what the nurse is asking and what type of step the provider has to do. The MD, remember, so that by itself with fixed issue or you tell them, Listen, as is, this system will not work for us. So it’s very important. These are little delicate issues, but they will be hindrances in the routine process of a hospital, in the routing process of care. Recollection of long lists and multiple slides is not a successful method. A better method of learning is to use patterns and relationships. Mind-mapping is used to identify relationships by reviewing the information available. And in turn, improving the capture of that information and using it in the health care. So it’s not a tool that basically stores data. This one expression, this one statement is so important, I can’t even tell you how much important it is. Your role as an informatician honestly, is to fully understand the capabilities of the system that you are advocating or you’re facilitating, or you’re managing. Because in many cases, people who are using it, they think what they are doing. They are working with a glorified database. Basically, you dump data in it, you come back and you plot data from it. No, that’s not the case. Even in relational database. I would argue that’s not the case because as the name tells us, relational database tables are linked to one another. And through query’s, I’m able to slice and dice. I’m able to summarize. I’m able to provide certain slices of data that are more relevant to my user rather than inundating them with a massive amount of information that they need. Like it’s an ocean of data now they need to dig into it and get that information. They don’t have that time. So same deal. This concept here is mind mapping. Here is not somewhere that, oh, let’s just put all the data here and they’ll figure it out. No. You, the designer, the person who was the connector between the clinician and the vendor, will assist in that design. That’s super important. And by the way, it’s a large part of your Assessment Activity this week’s assessment activity. So please pay good attention. So the outcome that you produce is always, or sorry, is also relevant with what is required. Mind mapping is a process that discusses the main ideas that basically is relevant for the task or for the project. Not just the outcome and the process. Because if you’re only here is a good concept, I’ve come across a lot and I absolutely agree with it. Sometimes they say our house care. Sometimes a lot of times because it’s true the US healthcare system is anticipated to reach a quarter of our total GDP just in a few years. I think it’s projected in 2025. And right now, it’s either it’s at 19 or 20 per cent of our entire GDP. That’s a huge number. So it’s one of the most expensive industries. So some cutting or controlling cost is a great goal. Don’t get me wrong. But sometimes they say, cutting cause is not good if you sacrifice quality. So not all cost control is good. You know why? Because if you cut costs by diminishing, by reducing quality, we might, because this is a, this is an industry that deals with people’s lives. You might end up causing more harm if you just reduce the cost. So you might end up causing people to receive further care, be more inconvenienced and their lives lose functionality, which is in my opinion, huge. If. Procedure could have been done right the first time just because you are cutting costs, you brought someone who is not as expert in anesthesiology as needed. Okay. The person ended up with liquid in their lungs. Okay. That’s not good. Okay. Now, this person can just go on living because you’ve got cost. Okay, I’ll live with liquid in my lungs. That’s not gonna work. So they’re going to end up seeking more care, more expensive if they are a Medicare beneficiary, guess what? Who’s who’s paying is who’s paying? The Medicare, which is federal dollar. Sure, not all. Cost cutting is a good idea. That is very important to remember. So just focusing on the outcome is not a good idea. The process is only process is not a good idea. Main concepts all need to be considered. Complex processes can use several mindmaps for analysis. Mind maps are used to analyze problems and processes and develop treatment. Several robust tools exist. One of them that I’m recommending to you that to create mindmaps is called Mondo mall, which is a free tool by the way, and you can access it as I have provided you with the links here. Don’t wait until the last minute and send me an email. I’m using Mac, I’m using this. Let us connect with me earlier if you have an issue, okay? As I said, this is an advanced course and it should not be only attempted to finish the assessment activity on a Sunday afternoon. That’s really not the method. Below is a simple example of a mind-mapping figure. Now, here’s an interesting thing I’d say. Don’t think that this is a tool that will is a key for all types of problems. Because in healthcare, you might end up working with a treatment plan. That in and of itself includes several main parts. Why? Because includes coordination between different specialists. Includes two types of hospitalizations. Include the hospitalization and physical therapy and then reassessing how these two treatments are working for the patient. So you might end up needing more than just one of these maps to identify the proper way of the decision support system that is required in your case. The main steps in mind mapping, what are they? Defining a broad scope that will enable designers to consider all the scenarios. Adding visual tools like graphs that could improve the mapping of the concept details. Adding symbols, no hyperlinks, images will also save time and improve interoperability between different teams. Absolutely, I agree with that. Including peripheral ideas and thoughts into the mind-map. These ideas might not be necessarily included in the final version, but adding them could provide direction. Include topics or subtopics that will expand on the main topic. Okay, So that is critical to remember that a mind map could include all of these little concepts and components that will make the interoperability easier. You might come to me and say what interoperability? I’m the designer of the mind-map and I will use it. I will tell you absolutely that it will be incorrect because in our role as informaticians, we are the people who, who we are trying to connect between two different, or sometimes even more than two different groups. The developers, the users, how to understand the problem, what other stakeholders will need to participate. That’s why it’s basically multidisciplinary to be super honest here at topics and sub-topics to that map. Which is mainly recommended to include topics that possibly could become the primary topic when all ideas are outlined in a mind map. Below, as you can see, is an infection map basically that provides you with topics and sub-topics. As you can see, e.g. one area of it is the viral infection. Then in viral infection you have different types. And all these different types, or many of them are also linked to antibiotics. So that makes sense. You view or whoever is reading this map could be able to identify further knowledge text related to antibiotics that all last year we were using this this year. It’s not a good idea because. It’s been proven that people are developing resistance. You or people are developing other conditions using this type of antibiotic, whatever the case might be, so on and so forth. So we are basically trying to divide infections, parasitic, viral bacteria or whatever the case might be into different areas because they have different requirements. They have different topics relevant to each one of them. What else? Identifying knowledge gaps to discuss weaknesses that exist in interaction. So within the map, by the way, these areas could be accompanied by notes, determined future steps needed to improve them or eliminate such weaknesses. Again, maybe the dispensing, the drug dispensing machine has a certain requirements. So obviously if you’re working in a hospital and that requirement is specific to this hospital, you might want to make that note next to that. Antibiotics. Note here to specifically let it know that it be known. Let’s say that this type of issue exists. This type of verification is needed or you don’t have that verification and you’re suggesting that verification and error occurred? I don’t know. Two months ago and nurse gave the wrong medication to a patient that was not within the age range that could have used that type of dosage, then you might need to add that alert as a decision support system to that phase of the process near that specific node. I didn’t find areas in the mind map that require further research. So this is a wonderful topic by the way. So you create a mind map for a process in the hospital. But you and the leaders of the hospital and your manager, you all know that this area has always been a problem. Let’s say it’s the area of transferring the patient. Discharge has different types. Discharge somebody to whom you discharge, somebody to hospice, you discharge somebody to Lawn Care, Living Center, whatever the case might be, right. And you know that working with this one Care Center has discharging patients. That has always been problematic. So you might add a section there that this area needs research. This area we need to find a link or a proper contact point. And I’m just creating examples here. I’m not specific, so but these are aspects that Devon definitely could be discussed. So I didn’t find a contact point within that living center that we discussed with them and we let them know what exactly the discharge notes and instructions are for future to prevent future issues. So that’s very important. The mind-map could be later used as the primary outline that could be used in a project to enhance on a certain area identified in a mind map. Again, certain areas of what? Certain areas maybe further research. Certain area of, for a certain area of maybe collaboration. Maybe you need a physical therapists opinion. In this one case. Maybe it’s the hip and knee replacement. And in the discharge process, it’s always useful to have that additional opinion instead of just leaving it on the patient and saying, Oh, in four days or a week, you have to visit a physical therapists and most of your patients are older. I don’t know. Maybe 80 average ages 80. They don’t have that capability. They don’t drive whatever the limitation is. So maybe it’s best to do that evaluation in the hospital before they leave. So you identify that gap. You allow that gap to be identified so that in the future it gets resolved. So at least somebody is discharging after such as surgery. They get that question. On the discharge note. Did the patient is the patient blah, blah, age. Okay. Yes, they are. Did the patient get a visit from the physical therapist? No, they didn’t alert right there, at least, you know, for future that definition came up related to this issue. It is identified you had pointed that out on your map. Finally, reorganizing the draft or different versions of the mind map is an essential step to prioritize the topics that require additional focus by the team members are identified the missing elements that must be developed. So this is a very important ideal. So what you are doing is basically you’re trying to. Update your map or edit your map based on needs. And I would say even based on audience, okay. Maybe in this group, they are, their priorities, are these issues versus another group that they have different priorities. Priorities. What are the benefits, say we because through all this trouble we created, why? Why are we doing this? So I would like, even without reading it, obviously, it clearly will save us time and will improve efficiency. But how it’s a tool used in healthcare to assist in decision-making process. Why? Because you’re identifying your kinda breaking down the processes that you have. And I didn’t find what possible under what section, what area? So if decision support system is needed, you exactly know in what case, in what section. So you don’t evolve, involve people who are not needed. You don’t create a big issue and take a lot of time out of other people’s routine or daily tasks to create this decision support system. But you target exactly the people who must know and must be involved. Large, some of them formations. So there you go. Saving time available and relevant to the decision-making process. A very cumbersome and not practical. If I give a clinician, a provider, let’s say a Dr. I don’t know. I think many of us see this. You go to the Dr. and they have a post visit summary, something like that. They give you and you look at it. It’s like nine pages. And I don’t know how many people really read that. They tell you about the drugs that possibly can be good. The drug actually darker already told you that you don’t need that, but still you get all that data. Now you fortunately or not in it, which is kind of fortunate and unfortunate, I would say in a decision making seat. Right? You’re you’re the patient. Mostly. They tell you and we do it do this and we do it. In my opinion, there’s a larger area for the patient to be involved in the decision-making process. But that’s fine. Let’s even past that. But a Dr. a physician in the patient provider encounter is absolutely in a decision-making process. They’re trying to make a decision whether this patient should go through surgery or not. That’s I would say that’s a huge decision. Now, you give them, I don’t know, 30 pages here. These are all the information relevant to this types of infections and these are the different aspects of it. Do you think that 15 min in that 20-minute time, they are able to read that fully, apply their patients characteristics to that data and that 30 pages and give you a proper efficient outcome that is very close to accuracy, accurate decision-making. Because in health care, it’s rarely 100%. You’re usually 90%. You are even when a Dr. says 100% at actually scares me more. There was a documentary, I forget the name on HBO. One of the issues that occurred, the People Act or the family, and I believe that one of the family members of that patient was himself in Hollywood at some position director or something. And one of the issues that I remember from the documentary was that the narrator was saying the only reason we accepted was that the Dr. said, I am 100% sure. We don’t have to worry about this blood center that your family member is on. So let’s let’s move forward and I’ll try to find a name and give this to you in a subsequent video. But if you have seen it also, it’s about medical errors. I don’t remember the exact name of the documentary. But one of the problems was that the physician specifically was 100% sure. You know, what I’m trying to say here is that it’s very hard to come by in healthcare. But what is beneficial? We came from dumping a ton of data on physicians and telling them here make the decision. And let me tell you one thing. I don’t believe in human error as much as I believe in system error when it comes to health care. And I want you to dig into that concept. Please look into that concept very carefully. It is very easy when an error occurs. So just find one person and say here, This person was at fault. Let’s go after them. That’s the wrong attitude. Look into the system because that individual being in that position was not only their decision, that individual dealing with that process or dealing with that specific area of the process of the cycle wasn’t only their decision. Okay? Of course. I mean, if somebody was malicious, if even they were told to do so, they did the exact opposite. Or they’re committing fraud on purpose. Absolutely. They must be found and detected and whatnot. But I would strongly say. Errors. Errors are usually a system issue, not a human issue. So when we are talking about data, we should have systems that are capable of identifying how this data is relevant. In this patient’s case, demographic wise, age wise social determinants of health include it. All these aspects should be done in an electronic, but accurate because some of the systems are not very accurate and those systems actually scare physicians. Reviewing a large sum of information, mind-mapping is used to the overload of information in healthcare. Again, timing issue, efficiency issue that could occur due to the large sum of health data gathered from different sources. A large percentage of medical errors are due to miscommunication. And using mind maps could minimize these errors as it will display relevant information and enable clinicians to discuss and agree on best treatment approach. In addition, if topics used in mind map are vast, additional files could be used to further expand on subtopics. Now, one person might say, well, you are saying create a mindmap, but when it’s massive amount of information, the mind-map or be massive. But remember, you can identify different processes and give a mind map to each one of them. And as I said a little while ago, involve the right stakeholders that are involved in that process. If you have someone who takes to usually transfers the patient from the recovery room to the car that they are being released. Okay. But wheelchair is broad, patient is sitting in it and being taken to the car that they will be leaving the hospital, would that person is not necessarily involved with the discharge instructions as much as the nurses are, however, that patients sorry, that person might be more involved with other aspects of care that they can be influential and such as noticing different aspects that maybe are important for the patient, but the nurse did not notice it and bringing that up to the discharging process or whoever is this discharging the team nurse or whoever the case might be. So there are different elements in any given care process, like every other industry. And not everyone must be involved in everything. So that massive amount of information definitely needs to be identified in a manner of areas of interests, prioritization, relevance, department relevance, what the pardon is associated with it. Some mindmaps actually might involve more than one department. So that’s kind of more of an upper level management mind-map. One might say, some are very specific to certain processes, Sean and so forth. So it’s very important to identify exactly what is the goal, who are the audience for this specific mind-map? And how it will identify the gaps. I will start a sorry, I will stop at this point. As mentioned previously, reach out if you have any questions. • • • • • • visualization models and diagrams are essential methods of communication and capturing insights. These models have been also developed to visualize the human thinking. Mind-mapping is one approach that assists in organizing the human thought processes Mind-mapping is a tool used for decision-making to prioritize problems and identify gaps in the model. Mind-mapping is used to plan the treatment options, determine diagnostic options, and assign best resources for issues identified. Recollection of long lists and multiple slides is not a successful method of learning. A better method for learning is to use patterns and relationships. Mind-mapping is used to identify relationships by reviewing the information available which in-turn improves the capture and use of the information in clinical/health care. Mind-mapping is not a tool that stores data. Mind-Mapping or Concept-Mapping • • • • Mind-mapping is a process that discusses the main ideas in a concept that is being studied and not just the outcome of the process. Complex processes can use several mind-maps for analysis. Mind-maps are used to analyze problems, improve processes, and develop a treatment. Several robust tools exist that could be used in developing mind-maps. In this module we will review Mindomo – free web-based mind-mapping tool – a free version of the tool is available here and a brief introduction to the tool features could be accessed here Below is a simple example of mind-mapping figure that discusses different types of infections: The main steps included in mind-mapping: • • • • Defining a broad scope that will enable designers to consider all possible scenarios and cases Adding visual tools like graphs and symbols could improve the mapping of the concept details. Adding symbols, notes, hyperlinks, and images will also save time and improve interoperability between different teams Include peripheral ideas and thoughts into the mind-map. Ideas that might not be necessarily included in the final version but adding them could provide direction to include topics or subtopics that will expand on the main topic of the mind-map. Add topics and subtopics to the mind-map. This step is mainly recommended to include topics that could possibly become the primary topic when all ideas are outlined in the mind-map. Below we add several subtopics to the main mind-map of infection discussed above • • • Identify knowledge gaps to discuss weaknesses that exist in the interactions depicted in the mind-map. These areas could be accompanied by notes that determine future steps needed to improve them or eliminate such weaknesses. In the example above relieving symptoms might not practiced based on the organizations protocols (clinical guidelines) and further improvement could improve the outcomes of the care services provided. Identify areas in the mind-map that require further research. The mindmap could be later used as the primary outline that could be used in a project to enhance on a certain area identified in the mind-map. Finally reorganizing the draft or different versions of the mind-map is an essential step to prioritize the topics that require additional focus by the team members or identify the missing elements that must be developed to improve performance. Benefits of Mind-Mapping in Healthcare • • Mind-mapping is a critical tool used in healthcare to assist in the decision-making process Reviewing a large sum of information available and relevant to the decision-making process is very cumbersome and not practical. • • 1 However, utilizing mind-maps could improve this process by gathering, organizing, and connecting the collected information. Mind-mapping is used to prevent the overload of information in healthcare that could occur due to the large sum of health data gathered from different sources. Also a large percentage of medical errors are due to miscommunication and using mind-maps could minimize these errors as it will display relevant information and enable clinicians to discuss and agree on best treatment approach. In addition if topics used in a mind-map are vast, additional files could be used to further expand on subtopics in the primary mind-map and discuss details in the form of main topic in the new file. • • • • Clinical decision support (CDS) systems are used to support clinical teams by providing knowledge and information that could be organized and customized for specific patient cases. CDS systems are designed to improve the quality of care provided by using information technology and health data digitization. Main goals of CDS systems: o Potential drug interaction o Assessing risk of treatment plans based on patient’s medical history o Providing clinical guidelines during the treatment process to improve care standardization Knowledge-based CDS systems that include compiled clinical knowledge. Patient-specific information and communication tools are used in CDS systems to support the clinical teams in care delivery services. CDS systems could be embedded or attached to the EMR system or could be an independent application from the health information systems in-use by the clinical team. CDS systems design attributes: • • • • The care area that the CDS system is designed to solve (aid in the diagnosis, send reminders for drug interactions,…) The users who will mainly utilize the CDS system and the level of knowledge required when system output is designed (physicians may require additional details to accompany the alert, while nurses might need a physician contact to consult in case the outcome is not similar to the information provided in the CDS system) The users control is an important aspect that must be also considered in the CDS system design and implementation phases. CDS systems are designed to serve in different roles o Remind clinical team members of tasks that they must complete o Assist the clinical team members by providing information when needed o Provide support in the form of corrective actions o Provide alternate plans for clinical team members CDS systems could be used in different areas of care: • • • • preventive care by accessing sets of clinical paths required for certain patients Diagnosis through accessing health databases that include relevant care information to the patient’s status Treatment monitoring that include detecting adverse drug interactions. Follow up care through alerts designed to prevent adverse outcomes. The Role of CDS Systems • • • • CDS systems are designed to support the clinical team during the decision-making process They often provide potential solutions or send alerts that require the attention of the team CDS systems are implemented to reduce cost and control harm to the care system Reducing waste and harm will also enhance patient satisfaction. Minimizing the number of duplicated tests or x-rays and ensuring that adverse drug interactions do not occur are all aspects that will improve patients’ experience. The Impact of CDS Systems • Assessing CDS system’s impact by using the classic quality comprising structure of Donabedian’s model (structure, process, and outcome). The • • structure is further expanded as people, organization, technologies, tasks, and environment by Carayon and colleagues. Most studies have evaluated the process and outcome of care services. An important aspect in the CDS system impact is to consider the methods that the system is being used for. In the case of CDS systems that produce alerts the design of these alerts must be designed to improve attention to them. To improve the chances for alerts to be considered by the clinical team members several options have been studied: o Presenting the alert in a way that the user must choose to view the information – on demand o Presenting alerts without any interruption to the daily tasks of the clinician o Not requiring response for less serious alerts o Display alerts with specific information that assists clinicians in selecting the subsequent actions o Designing alerts using the “tiered alerts” approach to assign the severity of the alert with the ability of ignoring the alert. CDS system’s users’ actions will vary based on the severity displayed in the system. o Alert fatigue is a serious issue in the process of using CDS systems. CDS systems must be designed to be integrated seamlessly into the health information systems and generate alerts that are not disruptive to the process of care or to the work of the clinician. o CDS system implementation will also impact the structure of the organization that is implementing it. Organizations must include the time required to use the CDS system in their care delivery services to allow clinical team members ample time to use and benefit from the information provided.
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