The Bipolar Spectrum Diagnostic Scale (BSDS)

THE BIPOLAR SPECTRUM DIAGNOSTIC SCALE (BSDS)

Instructions:

(Please read through the entire passage below before filling in any blanks.)

Some individuals notice that their mood and/or energy levels shift drastically from time to time______.

These individuals notice that, at times, their mood and/or energy level is very low, and at other times, very high______.

During their ''low'' phases, these individuals often feel a lack of energy; a need to stay in bed or get extra sleep; and little or no motivation to do things they need to do______.

They often put on weight during these periods______.

During their low phases, these individuals often feel ''blue'', sad all the time, or depressed______.

Sometimes, during these low phases, they feel hopeless or even suicidal______.

Their ability to function at work or socially is impaired______.

Typically, these low phases last for a few weeks, but sometimes they last only a few days______.

Individuals with this type of pattern may experience a period of ''normal'' mood in between mood swings, during which their mood and energy level feels ''right'' and their ability to function is not disturbed______.

They may then notice a marked shift or ''switch'' in the way they feel______.

Their energy increases above what is normal for them, and they often get many things done they would not ordinarily be able to do______.

Sometimes, during these ''high'' periods, these individuals feel as if they have too much energy or feel ''hyper''______.

Some individuals, during these high periods, may feel irritable, ''on edge'', or aggressive______.

Some individuals, during these high periods, take on too many activities at once______.

During these high periods, some individuals may spend money in ways that cause them trouble______.

They may be more talkative, outgoing, or sexual during these periods______.

Sometimes, their behavior during these high periods seems strange or annoying to others______.

Sometimes, these individuals get into difficulty with co-workers or the police, during these high periods______.

Sometimes, they increase their alcohol or non-prescription drug use during these high periods______.

Now that you have read this passage, please check one of the following four boxes:

( ) This story fits me very well, or almost perfectly

( ) This story fits me fairly well

( ) This story fits me to some degree, but not in most respects

( ) This story does not really describe me at all

Now please go back and put a check after each sentence that definitely describes you.

Scoring:  Each sentence checked is worth one point.  Add 6 points for ‘‘fits me very well,’’

4 points for ‘‘fits me fairly well,’’ and 2 points for ‘‘fits me to some degree.’’

Total Score = _________

Health Information Technology

For regular updates on health information technology, electronic medical records, electronic health records, CPOE, CDS, clinical decision support rules, HL7, HIPAA rules, CPT codes, ICD codes, functional documentation, implementation documentation, etc, etc, etc., follow this blog.

Clinical Decision Support (CDS)

Clinical Decision Support (CDS):

It is an interactive decision support system (DSS) Computer Software, which is designed to assist physicians and other health professionals with decision making tasks, as determining diagnosis of patient data.

·         Clinical Decision Support systems link health observations with health knowledge to influence health choices by clinicians for improved health care

·         CDSS provides physicians and nurses with real-time diagnostic and treatment recommendations. The term covers a variety of technologies ranging from simple alerts and prescription drug interaction.

·         CDSS may be used as part of CPOE and EHR

There are two main types of CDSS:

•                    Knowledge-Based

•                    Non-Knowledge-Based

Features of a Knowledge-Based CDSS:

•                    CDSS consist of three parts, the knowledge base, inference engine and mechanism to communicate.

•                    An advanced user could edit the knowledge base to keep it up to date with new drugs.

•                    The inference engine combines the rules from the knowledge base with the patient’s data.

•                    The communication mechanism will allow the system to show the results to the user as well as have input into the system.

Features of a non-Knowledge-Based CDSS

•                    CDSS’s that do not use a knowledge base use a form of artificial intelligence called machine learning, which allow computers to learn from past experiences and/or find patterns in clinical data.

Two types of non-knowledge-based systems are

§  Artificial neural networks and

§  Genetic algorithms.

•                    Artificial neural networks use nodes and weighted connections between them to analyze the patterns found in the patient data to derive the associations between the symptoms and a diagnosis.

•                    Genetic Algorithms are based on simplified evolutionary processes using directed selection to achieve optimal CDSS results. The selection algorithms evaluate components of random sets of solutions to a problem.

Electronic Health Records (EHR)

Electronic Health Records (EHR):

An electronic health record (EHR) is a growing concept defined as a methodical collection of electronic health information about individual patients or populations.  It is a record in digital format that is hypothetically capable of being shared across different health care settings.  In some cases, this sharing can occur by way of network-connected enterprise-wide information systems and other information networks or exchanges.  EHRs may include a range of data, including demographics, medical history, medication and allergies, immunization status, laboratory test results, radiology images, vital signs, personal stats like age and weight, and billing information.

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Difference between EMR and EHR

Difference between EMR & EHR:

Electronic Medical Records	Electronic Health Records
The legal record of the CDO	Subset (i.e. CCR or CCD) of information from various CDOs where patient has had encounters
A record of clinical services for patient encounters in a CDO
Owned by the CDO	Owned by patient or stakeholder
These systems are being sold by enterprise vendors and installed by hospitals, health systems, clinics, etc.	Community, state,  or regional emergence today (RHIOs) – or nationwide in the future
May have patient access to some results info through a portal but is not interactive	Provides interactive patient access as well as the ability for the patient to append information.
Does not contain other CDO encounter information	Connected by NHIN

Types of Technology in Healthcare

Types of Technology:

·         Electronic Medical Records (EMR)

·         Clinical Decision Support (CDS)

·         Computerized Physician Order Entry (CPOE)

Electronic Health Record (EHR):

An electronic health record (EHR) is an evolving concept defined as a systematic collection of electronic health information about individual patients or populations.  It is a record in digital format that is theoretically capable of being shared across different health care settings.  In some cases this sharing can occur by way of network-connected enterprise-wide information systems and other information networks or exchanges.  EHRs may include a range of data, including demographics, medical history, medication and allergies, immunization status, laboratory test results, radiology images, vital signs, personal stats like age and weight, and billing information.

Electronic Medical Record (EMR):

An electronic medical record (EMR) is a computerized medical record created in an organization that delivers care, such as a hospital or physician's office.  Electronic medical records tend to be a part of a local stand-alone health information system that allows storage, retrieval and modification of records.

Clinical Decision Support (CDS):

It is an interactive decision support system (DSS) Computer Software, which is designed to assist physicians and other health professionals with decision making tasks, as determining diagnosis of patient data.

·         Clinical Decision Support systems link health observations with health knowledge to influence health choices by clinicians for improved health care

·         CDSS provides physicians and nurses with real-time diagnostic and treatment recommendations. The term covers a variety of technologies ranging from simple alerts and prescription drug interaction.

·         CDSS may be used as part of CPOE and EHR

There are two main types of CDSS:

•                    Knowledge-Based

•                    Non-Knowledge-Based

Features of a Knowledge-Based CDSS:

•                    CDSS consist of three parts, the knowledge base, inference engine and mechanism to communicate.

•                    An advanced user could edit the knowledge base to keep it up to date with new drugs.

•                    The inference engine combines the rules from the knowledge base with the patient’s data.

•                    The communication mechanism will allow the system to show the results to the user as well as have input into the system.

Features of a non-Knowledge-Based CDSS

•                    CDSS’s that do not use a knowledge base use a form of artificial intelligence called machine learning, which allow computers to learn from past experiences and/or find patterns in clinical data.

Two types of non-knowledge-based systems are

§  Artificial neural networks and

§  Genetic algorithms.

•                    Artificial neural networks use nodes and weighted connections between them to analyze the patterns found in the patient data to derive the associations between the symptoms and a diagnosis.

•                    Genetic Algorithms are based on simplified evolutionary processes using directed selection to achieve optimal CDSS results. The selection algorithms evaluate components of random sets of solutions to a problem.

Computerized Physician Order Entry (CPOE):

It is a process of electronic entry of medical practitioner instructions for the treatment of patients (particularly hospitalized patients) under his or her care.  These orders are communicated over a computer network to the medical staff or to the departments (pharmacy, laboratory, or radiology) responsible for fulfilling the order.  CPOE decreases delay in order completion, reduces errors related to handwriting or transcription, allows order entry at point-of-care or off-site, provides error-checking for duplicate or incorrect doses or tests, and simplifies inventory and posting of charges.

Features of CPOE:

·         Ordering:  Physician orders are standardized across the organization, yet may be individualized for each doctor or specialty by using order sets.  Orders are communicated to all departments and involved caregivers, improving response time and avoiding scheduling problems and conflict with existing orders.

·         Patient-centered decision support:  The ordering process includes a display of the patient's medical history and current results and evidence-based clinical guidelines to support treatment decisions.

·         Patient safety features:  The CPOE system allows real-time patient identification, drug dose recommendations, adverse drug reaction reviews, and checks on allergies and test or treatment conflicts.  Physicians and nurses can review orders immediately for confirmation.

·         Intuitive Human interface:  The order entry workflow corresponds to familiar "paper-based" ordering to allow efficient use by new or infrequent users.

·         Regulatory compliance and security:  Access is secure, and a permanent record is created, with electronic signature.

·         Portability:  The system accepts and manages orders for all departments at the point-of-care, from any location in the health system (physician's office, hospital or home) through a variety of devices, including wireless PCs and tablet computers.

·         Management:  The system delivers statistical reports online so that managers can analyze patient census and make changes in staffing, replace inventory and audit utilization and productivity throughout the organization.  Data is collected for training, planning, and root cause analysis for patient safety events.

·         Billing:  Documentation is improved by linking diagnoses (ICD-9-CM or ICD-10-CM codes) to orders at the time of order entry to support appropriate charges.