Clinical & Business Decision Support: Tech support

Providers are still feeling their way around clinical decision support – and figuring out how best to integrate it with business intelligence to survive in an era of accountable care.

Data warehousing and decision support aren't exactly new. "Hospitals have had data warehouses for a long time," says Mary Griskewicz, senior director of health information systems at HIMSS. "I was working at a hospital 15 years ago, and we had one."

What is new these days is the ways clinical and business decision support are being used, and how they intertwine. And how the stakes are higher than ever for making them work.

Simply put, as the inexorable push for value in healthcare continues, "we cannot afford to keep performing the way we're performing," says Griskewicz. In this new landscape, "it all boils dow to the CIOs and the executives saying, 'We need to be more effective and efficient.' The best way to do that is to look at the data, and understand it."

James Gaston, senior director of clinical and business intelligence at HIMSS, agrees. "Fee-for-service is not going to be around for very much longer," regardless of how the Supreme Court rules on the Affordable Care Act, he says. "Payers and self-insured large businesses are all pushing to get value. And for a healthcare organization to respond to that, they need clinical intelligence. We're going to see more organizations dip their feet in this pool and figure our how they can effectively implement it in their culture and their structure."

Business analytics is well-established, but the shift in importance toward clinical intelligence is relatively recent. But both must work in tandem to gauge and deliver quality.

"Ten to 12 years ago, a lot of the larger hospitals all had data warehouses, that was the cool thing to do," said Griskewicz. "They had a lot of data, but they were using it basically for the C-suite, more on the financial management side – for your supply management, your inventory control. There was not a lot of emphasis to look at clinical informatics unless you were in more of an academic research facility."

Nowadays, not only is CDS coming much more to the fore, but "you're starting to see that cohesion" of both strains of intelligence, says Griskewicz. "We need to align the clinical informatics with the business informatics, because the business is that of healthcare."

From large academic medical centers to small community hospitals, the need to understand "how many 'Xs' I'm doing, and what are the clinical outcomes," is more acute then ever, she says.

"Because we're now going to be measured not only by CMS and the Medicare and Medicaid programs, but the larger insurers are basically saying, through value-based purchasing, 'If you meet the basic requirements the government is putting in front of you, we'll give you X amount of additional dollars as an incentive.'"