Five ways to maximize clinical support tools

Clinical Decision Support (CDS) tools are improving outcomes for patients across the country.

“CDS is often a misnomer to describe electronic health record (EHR) alerts that provide guidance on care delivery. However, the term can mean any tool that assists team members in making timely, informed decisions about patient care that will improve their outcomes,” says Jonathan French, director of health information system, quality and patient safety at the Healthcare Information and Management Systems Society (HIMSS). Those tools can include computerized alerts and reminders for providers and patients; clinical guidelines; condition-specific order sets; focused patient data reports and summaries; documentation templates; diagnostic support; and contextually relevant reference information, according to HealthIT.gov.

French describes how CDS has improved outcomes at the four-hospital, Hawaii Pacific Health (HPH) system in Honolulu. “Despite having a patient population with much higher colorectal cancer rates than the national average, their ambulatory clinics were in the bottom 50th percentile in delivering cancer screenings. HPH established a standard alert that red-flagged patients overdue for screening and created workflow to schedule screenings,” he says. The result: “After implementation of the intervention, measurement and reporting system and incentive program, HPH quickly improved to the 90th percentile nationally in colorectal screening.”

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The most effective CDS tools, says French, “deliver the right information to the right person using the correct CDS intervention format sent through the correct channel and at the right point in workflow.”

Indeed, HIMSS information states that CDS should enhance health-related decisions and actions “with pertinent, organized clinical knowledge and patient information to improve health and healthcare delivery.” Recipients of such tools include those involved in patient care delivery. The information sent may include general clinical knowledge, guidance, and/or patient data.

Hardwire it into the EHR

Scott Weingarten, MD, senior vice president and chief clinical transformation officer at Cedars-Sinai Medical Center in Los Angeles, California, says a CDS system “should be evidence based, accepted by clinicians, clinically meaningful, have low false-positive rates to prevent ‘alert fatigue’ and a measurable positive impact on patient care.”

Weingarten helped usher in Choosing Wisely, his hospital’s CDS, based on recommendations from dozens of medical specialties. He asserts that the best way to share CDS with clinicians is hard-wiring it into the EHR. “This will provide actionable information to influence clinical decision-making at the point of care,” says Weingarten, who underscores the importance of attaining Meaningful Use (MU) of EHRs. “The federal government made a $30 billion investment (in 2009) to subsidize the purchase of EHRs by physicians and hospitals and is seeking a clinical and financial return on investment (ROI). CDS, if properly implemented, could enable that ROI,” he says.

NEXT: Make the value clear to providers

Make the value clear to providers

Dan Armijo, vice president and director of health innovation and technical assistance at Altarum Institute, Ann Arbor, Michigan, cautions that “the decision to implement CDS is about much more than checking the regulatory box. Deploying CDS tools has to be driven by expectations for measurable improvement in clinical and financial outcomes. The aim is better aligning clinical practice to the evidence base. Meeting regulatory requirements is just something you do along the way.”

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French calls CDS “the best way to improve adherence to best practices. This is critically important as the recent repeal of the Sustainable Growth Rate ensures that all Medicare reimbursement be tied to improved clinical outcomes and value starting in 2019.”

Form a CDS work group

Providers must use five CDS interventions at the point of care to receive incentives offered by MU, says French. The American Health Information Management Association identifies the five rights as:

• The right information,

• to the right person,

• in the right intervention format,

• through the right channel, and

• at the right time.

“Providers receive an incentive by meeting the CDS metric and other measures of [meaningful use]. Nonetheless, CDS does not provide incentives for improved outcomes,” says French, who advises those wishing to embark on CDS to “first identify a local problem or poor adherence to best practice.

“To ensure provider acceptance, form a collaborative CDS work group composed of key stakeholders across the care delivery setting. Then, conduct a CDS five rights review. If the intervention doesn’t deliver on all five rights, identify another intervention,” he suggests.

Define your objectives

Weingarten says CDS should be evidence-based and come from a reputable source. “Healthcare executives should decide the intent of their CDS system prior to implementation, whether to improve patient safety, quality of care or safely reduce healthcare costs,” notes Weingarten. “Once the objectives have been identified, the executive should understand the types of CDS currently available. Then, they can decide whether they should make the CDS themselves, partner with other organizations who develop CDS, or buy from vendors.”

Make it relevant

Armijo advises that, when considering an investment in CDS, “focus on the key areas-such as clinical relevance of content, workflow integration, and usability. Incorporate the support of physician champions to verify the clinical utility and socialize peers.

“The key is to be relevant to the provider. If the physician or healthcare provider doesn’t see value in CDS content, then what you’ve done is add another bureaucratic layer to the delivery process and launched the provider community on a pursuit for creative documentation workarounds,” he says.

Lastly, says Armijo, “Look for products that allow you to tailor or overlay content to address specific organizational priorities or quality improvement efforts. Products have matured significantly over the past few years and thoughtful integration of CDS logic and content external to EHRs is, in many cases, less costly to maintain, more agile and up to date, and can be implemented in ways that are truly seamless to the user.”

Sherree Geyer is a writer in Phoenix, Arizona.