AMIA maps the road to decision support

By Bernie Monegain
12:00 AM

BETHESDA, MD – The American Medical Informatics Association aims to make clinical decision support a routine part of patient care. With the release Tuesday of its report “A Roadmap for National Action on Clinical Decision Support,” the group has begun the journey.

Information technology is a critical component of the plan, which was developed at the request of the Office of the National Coordinator for Health Information Technology.

In five years, if the roadmap is well executed, physicians will find that clinical decision support is more helpful, easier to use and a routine part of care, said Jonathan M. Teich, MD, one the authors of the report. Teich practices and teaches at Brigham and Women’s Hospital in Boston, which is affiliated with Harvard University.

“New medical knowledge will be available to include in a physician’s office system within days of its approval,” said Teich. “Imagine if your existing office system already had guidelines for use of the new cervical cancer prevention vaccine Gardasil. Pay-for-performance and vendor certification programs will be tied in with CDS, rewarding those who implement and use such systems.”

Jerome A. Osheroff, MD, another of the report’s authors, shares Teich’s vision. “The efforts under the roadmap to more widely share deployment experiences and strategies could, in the near term, help make it so that everyone knows and can do what the best of us know and are doing,” said Osheroff, chief clinical informatics officer for Thomson Micromedex and chairman of the CDS Task Force for the Healthcare Information and Management Systems Society.

The roadmap identifies three pillars that are needed to support widespread and optimal use of CDS to improve the quality of health and care delivery:

• Make the best knowledge readily available when it is needed – actions include building highly practical formats and services for representing, collecting, organizing, and distributing clinical knowledge and CDS interventions;

• Foster increased adoption and effective use – actions include organizing and publishing best strategies for improving CDS system design, usability, and implementation, as well as strategies for addressing legal and financial barriers; and

• Continuously improve CDS interventions and health-related knowledge – actions include developing systematic methods for sharing CDS experience and for leveraging electronic health records to enhance clinical knowledge.

Mark Leavitt, MD, chairman of the Certification Commission for Health Information Technology, applauded AMIA’s efforts.

“We support these strategic and tactical conclusions,” he said. “We are looking forward to continuing an effective dialogue with shareholder groups to develop a coordinated effort to facilitate adoption and nationwide use of clinical decision support systems,” he said.

Information technology will play a critical role in the success of the roadmap, said Teich.

“While CDS can be implemented in many media – such as paper forms and telephone-based systems – its most likely impact is in computer-based systems, particularly in EHRs,” Teich said. “CDS works best when it is very specific and relevant to the current clinical situation. The data stored in these systems can be used to fine-tune the internal logic rules so that a given guideline, alert, or information article only appears at those times when it would be most valuable. Then, once the intervention is presented to the physician and he or she makes decisions based on it – such as to change therapy – those changes can be easily captured in CPOE, eRx, or office EMR system.”

In Teich’s view, “it’s all about making the right decisions as easy as possible to come by, and as easy as possible to execute.”

Teich and Osheroff led the development of the AMIA roadmap. The other members of the steering group were AMIA President and CEO Don E. Detmer. MD; Blackford Middleton, MD, Partners HealthCare; and Richard Singerman, Elaine Steen and Adam Wright, Oregon Health and Science University. More than 70 experts and stakeholders from government, industry and academia participated in the panels and meetings.