HIMSS: CDS, as a facility-wide initiative, can improve quality outcomes
ATLANTA—If providers are able to overcome organizational improvement imperatives, as well as some technological considerations, clinical decision support (CDS) systems can facilitate the adherence to challenging quality achievements, according to Jerome A. Osheroff, MD, chief clinical informatics officer at Thomson Reuters, who hosted a CDS discussion at HIMSS10 today.
“Unlike other more sophisticated technologies, CDS needs to be utilized today for improved practice outcomes,” he said.
Each healthcare facility needs to assess whether these systems are producing positive results or inhibiting workflow, as well as figure out how to use the technology to optimize quality outcomes in the future, explained Osheroff. “Providers need to carefully consider processes as minute as what sequence to institute the technology facility-wide,” he said.
The current CDS definition, which was used in the recent meaningful use NPRM [notice of proposed rulemaking], is “to provide persons involved in care processes with general and person-specific information, intelligently filtered and organized, at appropriate times, to enhance health and healthcare.” Osheroff categorizes this definition as “very broad,” because it encompasses a variety of technologies, beyond the traditional CDS.
Osheroff stressed that CDS cannot be viewed as just rules and alerts, but as a “success formula.” Taking them from the 2009 CDS Guide, he outlined five basic "rights" of CDS that a facility needs to achieve in order to improve care outcomes with CDS:
Osheroff called these guidelines “deceptively simple,” but said if a facility is not getting proper results in using a CDS, the problem can usually be traced to one of these five rights.
In order for providers to find the “practical pearls” for improving outcomes with CDS, he also said that they need to ask these four questions:
One example of how a facility is using CDS for the proper means of validating outcomes came from Memorial Hermann in Houston, which is using the system for venous thromboembolism (VTE) improvement to ensure that every patient is getting properly documented and in the right sequence. In fact, many facilities are using the systems for VTE intervention, according to Osheroff.
Also, Memorial Hermann, along with many facilities represented in the audience, is using CDS to track all hospital-acquired infections. “This is a large quality problem that our leadership is pointing to us, asking if the computer can help,” Robert Murphy, MD, chief medical information officer from Memorial Hermann, which comprises 11 facilities. “Our leadership appealed to our middle level of executives in informatics and our chief nursing officer, asking us to work together on these challenges, especially if it’s (CDS) going to be effective system-wide.”
Osheroff pointed out that there is an ongoing “evolution” where departments address these aspects of quality of care, and new attention is paid to addressing challenges through a more integrated approach, as the drivers get more external pressure from CMS and other agencies. However, he added that “quality measures need to be an initiative from the top down.”
“People want to work on these problems, but they tend to work in segments. Ultimately, we need to see the board members engaged in order for effective change to take place,” Osheroff said. “Over time, hospital boards will take a much more active and proactive role—not necessarily micromanaging—but driving improved quality.”
“There is a tremendous amount of activity ramping up around CDS, especially with the meaningful use discussions, and increasingly hospital boards will recognize the value of these technologies to improve quality of care at their institutions,” Osheroff concluded.
“Unlike other more sophisticated technologies, CDS needs to be utilized today for improved practice outcomes,” he said.
Each healthcare facility needs to assess whether these systems are producing positive results or inhibiting workflow, as well as figure out how to use the technology to optimize quality outcomes in the future, explained Osheroff. “Providers need to carefully consider processes as minute as what sequence to institute the technology facility-wide,” he said.
The current CDS definition, which was used in the recent meaningful use NPRM [notice of proposed rulemaking], is “to provide persons involved in care processes with general and person-specific information, intelligently filtered and organized, at appropriate times, to enhance health and healthcare.” Osheroff categorizes this definition as “very broad,” because it encompasses a variety of technologies, beyond the traditional CDS.
Osheroff stressed that CDS cannot be viewed as just rules and alerts, but as a “success formula.” Taking them from the 2009 CDS Guide, he outlined five basic "rights" of CDS that a facility needs to achieve in order to improve care outcomes with CDS:
- The right information (evidence-based, useful for guiding action and answering question);
- To the right stakeholder (both clinicians and patients);
- In the right format (alerts, order sets, relevant display of data, answers, etc);
- Through the Right channel (internet, mobile devices, clinical information system); and
- At the right point in the workflow (to influence key decisions and actions).
Osheroff called these guidelines “deceptively simple,” but said if a facility is not getting proper results in using a CDS, the problem can usually be traced to one of these five rights.
In order for providers to find the “practical pearls” for improving outcomes with CDS, he also said that they need to ask these four questions:
- What are your improvement imperatives/CDS targets?
- Are CDS objectives being realized?
- Are current systems and tools fully leveraged?
- Are your critical success factors and key lessons learned?
One example of how a facility is using CDS for the proper means of validating outcomes came from Memorial Hermann in Houston, which is using the system for venous thromboembolism (VTE) improvement to ensure that every patient is getting properly documented and in the right sequence. In fact, many facilities are using the systems for VTE intervention, according to Osheroff.
Also, Memorial Hermann, along with many facilities represented in the audience, is using CDS to track all hospital-acquired infections. “This is a large quality problem that our leadership is pointing to us, asking if the computer can help,” Robert Murphy, MD, chief medical information officer from Memorial Hermann, which comprises 11 facilities. “Our leadership appealed to our middle level of executives in informatics and our chief nursing officer, asking us to work together on these challenges, especially if it’s (CDS) going to be effective system-wide.”
Osheroff pointed out that there is an ongoing “evolution” where departments address these aspects of quality of care, and new attention is paid to addressing challenges through a more integrated approach, as the drivers get more external pressure from CMS and other agencies. However, he added that “quality measures need to be an initiative from the top down.”
“People want to work on these problems, but they tend to work in segments. Ultimately, we need to see the board members engaged in order for effective change to take place,” Osheroff said. “Over time, hospital boards will take a much more active and proactive role—not necessarily micromanaging—but driving improved quality.”
“There is a tremendous amount of activity ramping up around CDS, especially with the meaningful use discussions, and increasingly hospital boards will recognize the value of these technologies to improve quality of care at their institutions,” Osheroff concluded.