By: John Alex, Senior Clinical Consultant
The birth of Clinical Decision Support (CDS) is forged from an unlikely path; born of the belief that healthcare should be accessible to all Americans. Lyndon B. Johnson ushered in Medicare and Medicaid in 1965, covering both elder Americans and those meeting specific criteria. Still many Americans were left uninsured. In 2004, George W. Bush openly recognized the need to expand access to healthcare created and nominally funded the Office of the National Coordinator for Health Information Technology (ONC). In 2009, Barack Obama used a small portion of the Emergency Economic Stabilization Act of 2008 bailout money to fund a real effort towards universal health care. In order to provide for this expansion, the delivery of healthcare would be put under a microscope to find and optimize efficiency and effectiveness. Thus, the “Health Information Technology for Economic and Clinical Health (HITECH) Act” was formed, along with plans to reform our delivery systems. A phased approach of reform called “Meaningful Use” was put into play.
CDS is a core objective within meaningful use. This is a consolidated objective, incorporating the Stage 1 objective to implement drug/drug and drug/allergy interaction checks. Stage 2 saw the larger encompassing objective of CDS; rolling up stage 1 drug/drug and drug/allergy check objective within, while tying into Clinical Quality Measures (CQM) and appropriate use criteria (AUC) checking. Stage 3 encourages expansion of its use, and opens the door allowing us to decide where it can best be used.
So what exactly is it?
CDS interventions are built into, or layered on top of, electronic medical reporting systems (such as RIS/PACS, CVIS, e-prescribing, or CPOE). They are tools intended to provide patient specific information to the right person at the right time within the workflow to improve efficiency, patient safety, and care. Center for Medicare and Medicaid Services (CMS) loosely defines the mechanics of CDS to promote creative approaches, but clearly spells out the intent and promotes the use of such interventions.
Potential benefits include:
- Diagnostic support and greater clinician confidence in diagnoses and treatment plan
- Inference engine applies an algorithm that references a knowledge base that can infer diagnoses and treatments
- Contextually relevant references to clinical guidelines (evidence-based guidance)Contextually triggered or searchable references Intelligent reminders of what to include in reports
- Prevention of incomplete or missing data
- Streamlined workflows and distributed workloads
- System understands who is interacting with the system and what information they are best capable of inputting
- Mitigated risk of drug interactions and other errors, preventing potential adverse events.System remembers current medications, allergies and disease states
- Improved efficiency and better clinician and patient experience
- Ability to leverage prior or normative test findings
Consider extending the use of CDS to your cardiology and radiology workflow. This can promote a better care environment and reduce costs with proper planning and execution. Understanding benefits and best practices around implementation is critical to achieving those goals.