How ThedaCare integrated CDS into its EHR

By Michael West, MD
08:10 AM
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For most healthcare organizations and physicians, the bigger picture of the health IT movement is beginning to come into focus. As multiple federal initiatives continue to unfold in tandem, the synergy behind everything from meaningful use to value-based purchasing is influencing two primary goals: higher quality and lower costs.

Increasingly, industry professionals are embracing the potential of automation and advanced IT infrastructures to move patient care to a higher plane. Reaching the level of interoperability and functionality needed to truly bring the concept of advanced IT infrastructures to fruition remains an uphill challenge for most hospitals, though. And one of the key barriers is integration.

In particular, clinical decision support (CDS) technology has been identified as an important element within an organization’s greater health IT strategy to standardize care and promote uptake and use of evidence-based practices. In an effort to deliver the most optimum care to patients, ThedaCare has always taken a progressive approach to advancing health IT. Based in Appleton, Wis., our five-hospital system identified early on that the ability to leverage fully-integrated CDS technology at the point of care would be essential to adoption of industry best practices across all facilities.

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Our goal is to ultimately move toward a problem-oriented workflow, where technology provides the appropriate documentation tool, which flows to the appropriate order set guiding clinicians step-by-step through the care process and ultimately delivers the most appropriate long-term care plan for the patient.

Deployment of Epic’s inpatient CPOE system was the first step, but it was clear from the start that the order sets to support CPOE workflows would have to come from another source. To adequately prepare for the quality expectations of the performance-based reimbursement landscape, we knew ThedaCare would need a more prolific order set authoring system than what was available in the EHR — one that could provide deep decision support and links to the latest industry evidence supporting care guidelines.

The reality is that EHRs were meant to be the beginning of the health IT movement, addressing the infrastructure needed to house patient records. Because EHRs were not designed to address the content needs to support a strong foundation of CDS, applications from both EHR and content vendors must be assimilated together.

We chose ProVation Order Sets, powered by UpToDate Decision Support to accelerate the order-set development cycle as well as draw on UpToDate’s robust supporting medical evidence. The easy, one-click automated maintenance function to keep content current was also a huge plus as well as the product’s ability to integrate well with the Epic EHR.

EHRs have inherent strengths — content is not one of them. To fully leverage and extend an EHR investment, healthcare organizations will need to draw on the expertise of content vendors, where clinical knowledge can be packaged in a concise way and delivered efficiently to the point of care. Making this happen on a high level will, of course, require cooperation between all parties.

Integration is a critical issue going forward, and it will take a concerted effort on the part of EHR vendors, content vendors and providers to collaborate on the most effective solutions. One of the greatest challenges to the use of decision support at the point of care is the ability to narrow and refine content to the needs of clinicians.

To draw on the full potential of CDS, applications will need to be able to talk to each other in full and, specifically, order sets will need to be able to “see” directly into the EHR to produce more intelligent guidance to fit the needs of a patient. For instance, in many cases, there are a standard set of questions for any lab test a physician orders that provide guidance for care. If the answers to those questions are already found in the patient record, why should a physician always have to navigate the same questions?

Advancing functionality in a way to truly meet the workflow needs of clinicians will also require that considerations be made for how CDS is integrated into workflows — whether via desktop or mobile — so that end-users can choose their preferred delivery vehicle for point-of-care CDS.

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Vendors that are willing to collaborate to blend “expert” tools together within an EHR will be best positioned to respond to the needs of the healthcare industry in the future. Ultimately, providers are looking for flexible infrastructures and a simple, intuitive process that works for clinician workflows.

The roadmap to integration has been paved with many challenges and opportunities. Meaningful use and other federal initiatives are helping increase momentum in this area since the expectation is that we not only “add” equipment now but also use it in a meaningful way that produces measurable results.

There is a logical hand-off between EHR and content vendors, and as an industry we can work to produce the standards needed to achieve seamless exchange of information. 

Healthcare providers are ready. Are vendors?

Michael West, M.D., is physician champion of the CPOE and data entry project at ThedaCare and a member of the HIMSS Physician Committee.


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