MU Stage 3: The promise of clinical decision support for preventive care
Implementing prevention after attending to chronic disease management or even hospital readmissions is like taking two steps backward to move one ahead.
What’s more, we will not trudge forward with the production of health in this country until prevention is brought into the daily workflow of our practices.
It’s worth noting that the Centers for Medicare and Medicaid Services lists Prevention as the number one of five clinical interventions. CMS wants us to get way upstream of disease to be effective in our emerging shared savings models and risk contracts — essentially to produce health not provide healthcare.
I see two technological methodologies by which health systems may meet the clinical decision support for intervention mandates in time for the proposed 2016 rule, those being patient portals or clinical decision support EHR modules.
Portals, of course, have been a somewhat contentious topic within the meaningful use discussion, but providers need to keep an open mind when it comes to patient engagement and portal usage. The features in your portal start with connecting patients to your office, getting callbacks or emailing your nurses, getting refills on medicines you prescribed. And implementing text reminders for visits to your office.
If your EHR has an API published that includes endpoints for true population identification, then most likely you will be able to have a care manager "prescribe" the intervention into the population's care plan within your patient portal. The rate-limiting step here then becomes the usefulness of your portal. If you can't get beyond 5 percent portal usage, then you will have a problem meeting 15 percent of patients who must self-track and receive "action" (taking a walk, for instance) and documented "user reaction" (i.e. a pedometer ticking up 3,000 steps).
I’m not suggesting this will be simple. Usability of portals and the rate of progression of the open APIs are bound to be the sticking points here. But there is a second way to implement clinical decision support interventions for those with lagging portal usability and API progression: standalone ONC-certified CDS modules.
The advantage here is that organizations can tap into emerging products that are built with a true user-centered design.
Moving forward physicians will have a "behavior change" formulary in addition to their e-prescribing formulary. Over time we can hope that the prescription of behavior change will start to eclipse the prescription of drugs. Of these products, the most important are those designed to prevent lifestyle disease, since this creates an estimated 80 percent of our healthcare costs. If we implement clinical decision support interventions for prevention thoughtfully, with compassion and caring, we will have compliance that eclipses the CMS requirements of 15 percent. Patients will use them because they don't want to disappoint us, and we will tell them we can observe and follow their usage of the tool and their user-generated biometrics behind the scenes.
Once a remote monitoring and prevention clinical decision support tool is implemented among the young of your population, returning to the office becomes something of a punishment for noncompliance, rather than the other way around.
Patients are ready for this. Many of them like using apps to measure and improve their health and are basically waiting for us doctors to tell them to do so. Over time, once this practice becomes the standard of care, health self-improvements will be a routine part of our patient's lives.