CASE STUDIES CHAPTER 8
1. Create a strategy to leverage the knowledge base of the practice against the value of knowledge within the developing ACOs. More often than not, physicians will respond to change in clinical practice with skepticism, despite research and clinical studies that prove a concept to be beneficial. The findings of Marjorie’s management team forecasted a 10-20 percent savings, which would definitely be supported by the accounting department. The alternatives that were discussed in Marjorie’s brainstorming sessions would all seem to be good ideas that would add value in order to satisfy Federal mandates. Tapping into the behavioral health expertise of all the participants in an ACO is one of the many reasons ACOs were established in the first place. Much like CDC couldn’t exist without the efforts of clinicians’ diagnoses in the past, the success of ACOs depends on as much participation as possible. In this situation, it would be best to incorporate all the structured data, but leave the clinical notes that are less formal out of the cloud and prevent them from being entered into the larger ACO database that other locations could access through one of the four types of knowledge-based decision support (EMR, HIE, EHR, PHR). These sections of records may contain informal notations regarding factors that would contribute to the mental health of the patient, but also certain information that would have to be filtered such as personal life-altering experiences such as rape, molestation, etc. This type of information is easy to gather and integrate into explicit patient information, but is difficult to filter through and formalize into structured experiential knowledge that would be beneficial to other caregivers or in future encounters. Decision support systems are based on sources of clinical decision making, and those sources need to be as accurate as possible. Excluding this would alleviate some of the concerns regarding the loss of...
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