Getting the Most Out of Your Clinical Decision Support Tools
Life is full of decisions. Some are not so important – what to wear, where to eat, what to watch on television. But others can be life-altering. Nowhere is this truer than making decisions about healthcare. In a very real sense, healthcare decisions can be a matter of life and death.
Physicians are faced with making decisions related to promoting the healthiest possible lifestyle for patients and providing the best medical care. But these decisions cannot be based on just a roll of the dice. They must be based on clinically appropriate knowledge and data that helps the clinician and patient come to a patient-focused treatment plan.
Fortunately, modern-day technology tools can effectively support the clinical decision-making support process. The availability of advanced “meaningful use” EHR systems now means that healthcare providers can integrate CDS, or clinical decision support, processes into their everyday patient interactions. The goal is to provide an in-depth approach that provides data at critical junctures which the physician can share with the patient to improve the care process and positively affect patient outcomes. By applying advances in artificial intelligence to the healthcare field, CDS systems can be used to:
- Automatically provide user prompts for decision-making purposes.
- Improve the overall clinical workflow by facilitating internal communication processes.
- Move the practice towards electronic templates that aid in the evaluation and diagnostic processes.
- Suggest additional medical activities at the time of the patient encounter.
- Provide overall care recommendations.
For example, CDS tools can quickly review the EHR to uncover a familial history of colon cancer, which the provider can review with the patient and suggest a more aggressive colonoscopy schedule. In an OB/GYN practice, the tools can unveil underlying factors that may point to a high-risk pregnancy, which can then be closely monitored by obstetrician and patient.
The main purpose of CDS tools is to not to replace the physician’s expertise, but to supplement and support it at the specific point of care. CDS tools quickly offer data to the physician, who can then analyze it based on the patient’s current symptoms and overall health history. The provider takes all this knowledge into account to make a more accurate diagnosis and recommend a more appropriate care plan.
CDS is a process that provides doctors with clinical knowledge and pertinent patient data to improve the process of making health-related decisions. It enables the physician to make more meaningful use of information stored in the EHR so a higher level of care can be provided.
This Knowledge Drop provides an overview of clinical decision support tools, outlines which tools are most important for meeting meaningful use requirements, provides a brief implementation process, discusses the Five Rights of Clinical Decision Support, and summarizes CDS benefits. Medical practices which utilize these tools will be able to apply knowledge in a more suitable manner, and they will also be able to practice healthcare more effectively.
What Are Clinical Decision Support Tools?
According to HealthIT.gov, CDS is a combination of evidence-based knowledge and patient-specific data, which is filtered intelligently and dispensed to care providers. The tools are incorporated as part of the EHR system, and they utilize a variety of activities to enhance decision-making during the clinical workflow process, including:
Computerized Alerts and Care Reminders
The EHR system may have built-in pop-up alerts to provide warnings, or remind the practitioner of actions that should be taken.
In cases requiring chronic care management, CDS tools can provide support for multi-step care plans that extend over longer periods of time. The physician can review evidence-based guidelines and recommendations, and view potential care pathways at the appropriate time for each affected patient. This information leads to increased documentation efficiency, which supports better long-term care decisions.
Condition-Specific Order Sets
Patient-focused data reports and summaries better enable the physician to choose from alternative care paths when treating specific conditions.
These templates can help busy providers ensure that relevant data is collected and charted to help in the decision-making process. Patient notes and physician insights can help to track symptoms, bring out the need for routine tests or lab reports, and provide an accurate record of care provided.
Diagnostic Support Tools
While physicians have a great deal of academic and practice knowledge on which to base a diagnosis, the pressure of office workflow sometimes means that a particular symptom or care indicator is overlooked. CDS can incorporate tools to provide contextually relevant reference information, which can aid in the diagnostic process.
Implementing CDS Tools
Although CDS can be a stand-alone tool, its most effective applications are often incorporated with existing technology as part of comprehensive EHR systems. Steps to take in implementing CDS include:
Create an Overarching Strategy
Think about the best ways to use analytics and information in your practice. Maybe you want to try to start with one area, such as filling healthcare gaps, and build from there. This will help you think about what information is needed to address that goal, so you will know what to pull from your EHR systems. Then discuss how your CDS tools can best organize that information and bring it to the doctor’s attention. Once that strategy appears to be functioning smoothly, move on to the next area, building on the elements you have learned while implementing the first initiative.
Be Willing to Be Flexible
Your data foundation needs to be stable and secure, so you can manipulate it easily to meet your different analytics purposes. That means starting with a solid EHR that gives you the flexibility to work with your patient data in many ways. Begin by pulling the key data sets and reports you need to address your first initiative, and then determine the best way of using that information in the decision-making process.
If your practice is like just about every other one in existence today, change and new technology can be hard to implement with the team members. Allow plenty of time to explain the CDS tools, and allow staff members to become proficient in using them. Again, start with a few simple queries and alerts, so they can see how helpful the tools are when it comes to making decisions, and you can build complexity as they become more comfortable with the process. Make sure the primary care providers are as proficient as the office staff at accessing and utilizing your information.
Involve Your Patients
Let your patients see what your practice is doing to improve the quality of the patient engagement and drive better healthcare results. Inform them when your system has prompted you to ask a question or suggest a follow-up, so they will buy into its helpfulness as part of the total patient experience. Your patient portal can also be used to follow-up on CDS tools when they recommend lab work or remind a patient to perform a self-test such as checking blood pressure or insulin levels. Ask for patient feedback so you can uncover better ways to use the decision tools at your disposal.
Getting the Most Out of a Successful CDS System
Failure to make a decision is still, in fact, making a decision, so decisions that are made must be based on the best available data and evidence-based medical information. Use your EHR systems to filter information, organize it logically, and present it to providers in a way that best supports the practice workflow.
The Medicare and Medicaid EHR Incentive Programs, also known as Meaningful Use, actually provide financial incentives to those eligible medical professionals who can adopt and demonstrate the “meaningful use” of certified EHR technology. This can be proved by improving the safety, quality, and efficiency of patient care. These rules require the providers to integrate clinical decision support (CDS) into their EHR systems, based on the five “rights” of clinical decision support:
According to The American Health Information Management Association, or AHiMA, the rules for Stage Two of Meaningful Use require that healthcare professionals must “implement five clinical decision support interventions” which are directly linked to four or more clinical quality measures, as published by the Centers for Medicare and Medicaid Services. They have listed five rights which can be used as a framework when planning to implement CDS interventions within a practice, including:
1. The Right Information
The information presented to the provider or the patient should be evidence-based, derived from a set of recognized guidelines, or based on a national performance measure.
2. To the Right Person
Depending on the specific situation, the right person can be a physician, nurse, physical therapist, or in some cases, an authorized significant other.
3. In the Right Intervention Format
CDS may be implemented in various formats such as order sets, alerts, protocols, patient monitoring systems, and information buttons. Choose the best format to resolve the problem being addressed.
4. Through the Right Channel
CDS interventions can be delivered through the EHR, computerized physician order entry, a smartphone app, or even paper forms if necessary, so long as it efficiently gets the necessary information to the decision-maker.
5. At the Right Time in the Practice Workflow
CDS should not be implemented to try to overlay on top of existing technology, but to meet the objective of providing the best information at the exact time it is needed. It may be that a lab test is prompted when the provider types in a certain diagnosis or specific medications.
When properly designed and implemented, physicians can obtain many key benefits from a successful CDS system by:
- Recognizing patient problem areas, or lifestyle areas in need of improvement.
- Utilizing the most relevant evidence-based information to make clinical decisions and create care plans.
- Reviewing multiple data points in order to obtain maximum actionable insights.
- Improving practice workflow and efficiency.
- Increasing patient care quality and outcomes, leading to higher patient satisfaction rates.
- Reducing fraud potential, care errors, and adverse patient events.
- Maintaining regulatory compliance.
- Decreasing CMS penalties and practice costs by improving care efficiency.
Don’t let your decision-making rely on a throw of the dice. Use Clinical Decision Support tools to make better decisions for your patients and your practice.