System Design and Management Reflection

Appropriateness of Clinical Decision Support Implementation and Use

Ideally, with the help of the CDS tools, healthcare organizations can improve quality of
health services, decrease errors and adverse events, and increase the satisfaction of patients as
well
as providers. However, inappropriate use of these tools and poor design may bring patient harm,
clinician alert fatigue, and adverse impact on clinical workflows. The objective of this white
paper is to discuss how to evaluate and improve the appropriateness of CDS implementation. It
includes literature review, solution description, Failure Mode Effect Analysis (FMEA), a quality
measurement plan and conclusion. After the literature review, the integration of “Think Aloud”
and “Near Alive” evaluation method was selected to be the appropriate solution. Then the author
did a Failure Mode Effect Analysis of this solution. Through the FMEA, the author indicated that
the analysis and modify parts are important since it is hard to tell how the CDS tools will work
after all the modifications in the real world. This white paper demonstrates the author’s
understanding of FMEA applied to a solution to current issues related to CDS tools.

Database Design Term Project
The government of San Diego County wants to know the situation of all the cities’ traffic
collisions to determine how to adjust their traffic enforcement. To do this, the data in 2014 were

captured from the website, California Office of Traffic Safety (OTS). These data include traffic
situations of all the 18 cities in San Diego County. The author used these data to create a well-
designed database.
The government wants to compare different cities’ collision statistics with similar
population size. In addition, they want to compare data from every city regarding alcohol-
involved collisions. The author used SQL to create two queries to extract related data from the
database and obtained the information needed by the government. The author also created two
reports to demonstrate traffic situation in San Diego County. Data analysis from the reports
showed that among the six cities in San Diego County with the population range from 50,001 to
100,000, the top 30% ranking collisions happened in two cities: National City and Vista. On the
other hand, the top three worst cities in San Diego County were Imperial Beach, Coronado and
National City based on the data of alcohol-related collisions.

System Analysis Project
This project demonstrates the system problems at the satellite NICU of Rady Children’s
Hospital at Scripps Encinitas. The admission workflow of this satellite NICU was presented.
Because of the utilization of two different EHR systems and two different database entries, this
situation caused several problems, such as HIPPA concerns, redundancy and possibility of
errors, high risk of displacement of orders, etc. The group identified the six types of wastes in
this system and provided four recommended solutions. Through this example of a health care
system design, the author demonstrated knowledge and skills in applying workflow analysis and
providing suggestions to promote system improvements.