Time to embrace decision support (not decision replacement) is now

Our industry needs to provide clinicians and the enterprise with usable CDS products that increase productivity including user satisfaction.
By David Lareau
11:48 AM
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There is mounting evidence that clinical decision support (CDS) tools can significantly improve patient outcomes. Earlier this year, Intermountain Medical Center researchers showed that the use of advanced CDS tools lower the mortality rates of patients being treated for pneumonia. This and other data clearly show CDS is effective at improving outcomes and reducing mortality.

Not only is this good news for the patient, it is also good news for our entire healthcare delivery system.

Centers for Medicare and Medicaid Services (CMS) and private payers are asking hospitals to adapt these tools and quickly.

First, CMS published an aggressive timeline to implement value-based purchasing and private payers are increasingly encouraging hospitals to agree to risk sharing contracts that emphasize care quality and cost savings. Second, Stages 2 and 3 of meaningful use significantly raises the bar requiring the use of five CDS interventions. And third, beginning in January 2017, the Protecting Access to Medicare Act of 2014 will require healthcare providers who order advanced imaging services for Medicare patients to use CDS when placing these orders.

Healthcare organizations looking to implement CDS, or improve their existing CDS tools, should consider the "five rights" concept that outlines five best practices to help ensure CDS is a valuable tool within the practice. These five rights are:

  • the right information – evidence-based guidance as a response to a specific clinical need;

  • to the right people – the entire care team, including the patient;

  • through the right channels – via EHRs, mobile devices, patient portals;

  • in the right intervention formats – this includes order sets, flow-sheets, dashboards, patient lists, among others; and

  • at the right points in workflow – delivered to the clinician for decision making or action

One of the biggest hurdles health systems may have to overcome to effectively implement CDS is resistance from the clinical staff. This resistance is most often based on a lack of understanding of the role CDS plays in healthcare, both what it is and what it is not.

It is critical that doctors and all caregivers understand that CDS is decision support, not decision replacement.

Providers of CDS tools and modules are very careful to indicate that CDS does not, in any way, trump the decision-making of the doctor or other clinicians. Instead, it is a tool that provides quick access to additional or relevant information and research on evidence-based care that leverages this information within the EHR. Using the right information can help tailor care to individual patients based on their current health status and medical history. CDS does not replace physician judgment. Rather it provides a richer set of relevant clinical information, drawn from the most current research, allowing the provider to make more timely, informed and higher quality care decisions.

Once clinicians have a better understanding and acceptance of CDS tools, it is vital that the right CDS tool is selected; one that is not disruptive to, but rather enhances clinical workflow. Doctors and other clinicians are, and with good reason, resistant to adapting new EHR environments. Many providers have gone through a number of EHR changes and platforms in their careers and as a result, may be hard-pressed to adapt to new EHR environments or enhancements, including CDS tools. The decreased productivity for physicians associated with disrupted workflows related to new EHRs is well documented.

Our industry needs to provide clinicians and the enterprise with usable CDS products that increase productivity including user satisfaction.

To spur adoption in the clinical setting and to get the full benefit from any CDS tool, health systems should look for solutions that can be easily added on to and even provide enhancements to an existing EHR. For example, CDS tools should work in tandem with, or in lock step with, documentation tools to both capture information and serve up critical clinical decision support information at the point of care. CDS should also allow for easy health-system-specific customization so that health systems can tailor their clinical decision support and documentation needs to the care they deliver, all while ensuring the system captures the most up-to-date and relevant information needed to provide clear, actionable information.