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Diving Deep into Clinical Decision Support

Clinical decision support (CDS) provides physicians, nurses, staff, and patients with information, “intelligently filtered or presented at appropriate times, to enhance health and healthcare,” according to The systems are designed to deliver the right information to the correct person at the right time.

CDS is also an industry that’s thriving in healthcare’s lengthening data shadow, providing a living for information annotators, curators, cataloguers and coding experts, clinical information clearinghouses, and others with the means to acquire or process data. Vendors offer a variety of tools that can integrate patient prescription information, common medication uses and diagnoses, and other assets to enhance decisionmaking at the point of care.

A recent review of studies evaluating CDS systems shows they are associated with improved clinical practice. The tools are getting handier every day because riding herd on clinical information is getting harder every day. For example, the number of medical journal articles rose from 200,000 in 1970 to more than 800,000 in 2010.

Medical practice

With the onslaught of literature published annually, a physician who reads two articles every day would be 1,225 years behind at the end of the first year, according an article in Healthcare IT News. The article was published last year, so even if that physician is a speed reader and retains all the information in these articles, he or she is now even farther behind.

Value-based reimbursement means quality improvement is now imperative and smart CDS is an essential part of that. If practices want to be paid in the years to come, it’s incumbent on them to show they’re delivering better care. CDS is one way to prove that. However, CDS must be approached as a lot more than EHR alerts, even in small practices.

CDS involves sharing information, which can be scary for physicians and patients alike. However, sharing clinical information carries the potential for better understanding about what works in patient care and what doesn’t.

The Agency for Healthcare Research and Quality (AHRQ), which supports efforts to develop, adopt, implement, and evaluate CDS in healthcare decisionmaking has some recommendations for CDS in physician practices. If you’re considering adding or updating CDS systems, consider:

  1. How does CDS apply to your practice? What are the most important things for the CDS system to accomplish? It is likely physicians want it to provide clinically appropriate alternatives, such as one drug over another, along with override options that allow clinicians to complete their task.
  2. You’ll also need to identify latent needs, which are supplemental recommendations in the CDS tool, and inform the users of the CDS tool. For example, if a CDS system’s primary function is to recommend an antibiotic for treating a specific infection, it could simultaneously fulfill a latent need to order therapeutic drug monitoring.
  3. How do you make it work? CDS systems must be as fast as possible at gathering and processing data and returning meaningful information or recommendations to users. Your EHR functionality shouldn’t be a limiting factor. It is helpful to ensure that the EHR’s functionality is completely understood and to build the CDS system to fit your existing workflow.
  4. To deal with the expanding universe of clinical data, the system must be relatively “simple.” Complicated systems might promise sophistication, but instead deliver expensive technology fails. At the other end of the spectrum, they might swamp the user with too much information or irrelevant support. Physicians and other clinicians should only be required to enter data when it’s essential.
  5. When guidelines change, CDS tools built on them must change as well, whether through automatic updates or replacement of the system. Vendors and users alike need to know when it’s time to pull the plug on CDS tools if they become obsolete.

Here are a few other important factors to consider. First, you must measure and share success. When a CDS tool is implemented, it changes how the users do their jobs. Measuring how end users are responding to the CDS tool and sharing data on clinical outcomes reinforces the value of their efforts and builds trust for future development.

Second, to optimize CDS capabilities and gain support at all levels of the practice, it is vital to develop a good relationship with the vendor. Even CDS systems built by physicians won’t necessarily meet your office’s needs. Therefore, it’s key that the vendor understands your practice’s specific requirements (and budget).

Third, developers that harness user-centered design approaches help ensure that CDS works for a range of users in a variety of contexts.

This brings us to a final thought on CDS. As these systems process more information, the decision support they provide becomes more powerful and more nuanced, because it is based on more conditions or data points. Practices of all sizes must make sure their EHRs and other systems can scale to meet the demands of CDS information delivery and regulatory data harvesting.

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