When a care event occurs, a consultation between the care provider and his/her patient creates data. The recording action of those data constitutes the basis of a patient chart. Clinical Decision Support (CDS) tools give those data life. If used appropriately, they can guide the provider. They were traditionally used as part of the treatment protocol, but can now be used in almost every aspect of the clinical workflow – from scheduling, to documenting, ordering, education, billing, follow-ups, reminders, and charting.
The Healthcare Information and Management Systems Society (HIMSS), the cause-based, not-for-profit organization defines Clinical Decision Support as a process for enhancing health-related decisions and actions with pertinent, organized clinical knowledge and patient information to improve health and healthcare delivery.
Many Electronic Health Records (EHRs) now offer various types of decision support tools. When it comes to their features, what matters most is functionality that fits with common clinical workflows. In a huge hospital network the provider is not in control of this type of tool, but in a smaller clinic or solo practice, it is widely expected that you can easily manage and tailor your decision support tool. CDS tools should not be limited to the patient chart and clinical workflow, but can also help streamline practice management functions.
CDS systems are primarily used for alert functions like drug-drug interaction, or drug allergies and conditions. Since the passage of the Health Information Technology for Economic and Clinical Health (HITECH) Act and the emergence of Meaningful Use, those alerts have been standardized and most EHRs now offer them. What is not traditionally offered to providers is the possibility to create their own custom alerts. But why not? EHRs should offer search capabilities for providers. As soon as you are able to define a query, why not save it and use it later with some kind of built-in intelligence?
Let’s say you want to search your patient panel for adults with hypertension. After narrowing down your list, you’d then refine your criteria to see which of those patients have their blood pressure recorded and how many haven’t. Then you record the query that tells you which patient record should be fixed with a record of blood pressure. A flexible and customizable CDS tool can help you remind providers to check the blood pressure of all other patients with hypertension. Save this query, then set a reminder that will pop up each time you open the patient chart like the warning band shown here.
The next step would be to develop a dashboard. Dashboards provide at-a-glance insight to clinical and financial data, and provide a useful starting point to investigate further. Dashboards can be tailored with data that are relevant for your practice.
When they think about CDS functionality, most providers envision a tool that diagnoses or at least advises on your behalf. The major gain with such a tool is that it can optimize practice performance. CDS tools display information and offer alerts but then do nothing with this information. So what about taking things to the next level? Envision a system that connects you with colleagues, staff and patients using rule-based logic. The concept is when the system finds a rule that matches, it can ask you whether or not it should execute said rule. As an example, it could prepare a lab order given the patient’s condition. The system could also communicate with patients about appointment times, issue pre-visit instructions, or disseminate educational information. And, it can communicate to your colleagues and prepare and send files for referral. Communication tasks and file preparation takes an enormous amount of practice time. With the many government rules and payer demands, any provider needs an army of staff, which then raises costs by adding more and more non-revenue activities.
Finally, a CDS tool that can be accessed via the Web has distinct advantages over client-server solutions. A web-based tool allows you to harness the power of the group. So, a practice support tool becomes a community support tool, and ultimately saves a great deal of customizing time (and consulting money). The system is then enriched by your network. Using rules created and maintained by someone you trust is like having an “intelligent” system. A care provider facing an unusual situation could then refer to his network for an answer, and validate and enrich built-in rules by his experience. It’s akin to having an automated staff for free!
Studies show that CDS tools can lead to performance improvement, but the adoption rate has been slow, particularly in small practices. Given their potential, CDS are extremely useful for improving patient outcomes, but with some innovation, they also present opportunities to save time and better manage your practice.
Jean-Francois Riverin is director of quality assurance and operations for Hello Health, the revenue generating EHR platform for primary care practices supporting practice vitality through patient engagement and electronic medical revenue.