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.

 

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