The AMDIS Connection | The Evolution of Decision Support
We’re moving well beyond rules and alerts smacking us in the face during order entry. Clinical decision support is evolving and changing in significant ways. Several issues are driving those changes.
While many studies have been published about the benefits of decision support, perhaps we also need to start looking more closely at liability. We’re rapidly evolving to the stage of needing the capability to know exactly what decision support a provider was presented with and when. Sometimes, we are limited by the vendor in our ability to track and measure these things. Oftentimes, facilities have to use surrogates or even manual extraction to tease together what the provider did or did not see and when. It can become an exercise in EHR forensics. We need to put some pressure back on the vendors to create a better toolset to help us see the totality of the EHR and human interactions.
Despite liability concerns, decision support continues to expand and evolve. We are well past simple rules and alerts; we’re in the world of dashboards, real-time notifications via mobile devices and predictive modeling. The great thing about the term “decision support” is that it applies to any intervention at any moment in time that helps the patient. I think of it as any guidance that ultimately improves the patient’s care, including face-to-face interventions with patients, too. Decision support now extends beyond the walls of our hospitals and, in fact, the real value proposition for EHR impact comes from effective decision-support deployment in the outpatient setting.
The decision-support evolution is evident in the push towards interoperability inherent in meaningful use and in patient portals through education and reminders. All of that is part of decision support. For example, if we are engaging patients to teach them how to improve their care or provide best practice reminders, we are assisting with their decision making.
It’s never enough to simply implement the system. The ability to step back and see the forest from the trees will continue to be important going forward. You will need a dedicated team working to continually enhance and optimize your EHR and decision support tools. I am fortunate enough to have an Office of Clinical Transformation that allows me to place physicians with protected time to work through this process and chair key councils, such as our Decision Support Council. Right now, there are more than 100 decision support intervention requests that this council is charged with prioritizing and working through. It can be a massive demand management problem. Getting to the next level requires constant evaluation and refinement of the processes.
That can be a tough sell. With imperatives like meaningful use and ICD-10 coming at us at 100 miles per hour, we are constantly pushed to do the next new thing, and not revisit yesterday’s install.
This effort requires a top-down commitment to refine and enhance. It would be foolish not to carve out the resources required to commit to those refining efforts. If that is not one of the top priorities at your facility, you’re not going to realize the benefits of your massive electronic investment. Meaningful use incentives and penalty avoidances are not the end goal, despite what some CFOs may think. That money is small potatoes compared with what we want these systems to achieve. That money is meant to offset the cost of implementing an EHR, not count towards the bottom line. The real end goal is improving patient outcomes, and hopefully, reducing costs.
While many studies have been published about the benefits of decision support, perhaps we also need to start looking more closely at liability. We’re rapidly evolving to the stage of needing the capability to know exactly what decision support a provider was presented with and when. Sometimes, we are limited by the vendor in our ability to track and measure these things. Oftentimes, facilities have to use surrogates or even manual extraction to tease together what the provider did or did not see and when. It can become an exercise in EHR forensics. We need to put some pressure back on the vendors to create a better toolset to help us see the totality of the EHR and human interactions.
Despite liability concerns, decision support continues to expand and evolve. We are well past simple rules and alerts; we’re in the world of dashboards, real-time notifications via mobile devices and predictive modeling. The great thing about the term “decision support” is that it applies to any intervention at any moment in time that helps the patient. I think of it as any guidance that ultimately improves the patient’s care, including face-to-face interventions with patients, too. Decision support now extends beyond the walls of our hospitals and, in fact, the real value proposition for EHR impact comes from effective decision-support deployment in the outpatient setting.
The decision-support evolution is evident in the push towards interoperability inherent in meaningful use and in patient portals through education and reminders. All of that is part of decision support. For example, if we are engaging patients to teach them how to improve their care or provide best practice reminders, we are assisting with their decision making.
It’s never enough to simply implement the system. The ability to step back and see the forest from the trees will continue to be important going forward. You will need a dedicated team working to continually enhance and optimize your EHR and decision support tools. I am fortunate enough to have an Office of Clinical Transformation that allows me to place physicians with protected time to work through this process and chair key councils, such as our Decision Support Council. Right now, there are more than 100 decision support intervention requests that this council is charged with prioritizing and working through. It can be a massive demand management problem. Getting to the next level requires constant evaluation and refinement of the processes.
That can be a tough sell. With imperatives like meaningful use and ICD-10 coming at us at 100 miles per hour, we are constantly pushed to do the next new thing, and not revisit yesterday’s install.
This effort requires a top-down commitment to refine and enhance. It would be foolish not to carve out the resources required to commit to those refining efforts. If that is not one of the top priorities at your facility, you’re not going to realize the benefits of your massive electronic investment. Meaningful use incentives and penalty avoidances are not the end goal, despite what some CFOs may think. That money is small potatoes compared with what we want these systems to achieve. That money is meant to offset the cost of implementing an EHR, not count towards the bottom line. The real end goal is improving patient outcomes, and hopefully, reducing costs.