Friday, September 25, 2015

Clinical Decision Support Is Becoming Increasingly Important - A Useful Update.

This appeared a little while ago:

Clinical decision support: no longer just a nice-to-have

Posted on Jul 14, 2015
By Mike Miliard, Editor
Since Hippocrates first brandished a pair of bronze forceps, care providers have aimed for quality. It's always been the goal to deliver safe and effective care to best extent possible.
But there's always room to improve. And nowadays, with the shift from volume to value finally taking hold, moving toward better clinical care is no longer optional.
This past fall, the U.S Department of Health and Human Services announced it will invest $840 million over four years to help 150,000 clinicians improve patient outcomes, reduce unneeded tests and avoiding unnecessary hospitalizations. One of the central pillars of its Transforming Clinical Practice Initiative is to help providers regularly use electronic health records to examine data on quality and efficiency.
A few months later, in January of this year, HHS upped the ante – making an 'historic' announcement of ambitious new timelines toward value-based care. Furthering its embrace of alternative reimbursement models such as accountable care organizations and bundled payments, HHS set a goal of tying 85 percent of all traditional Medicare payments to quality or value by 2016.
"We believe these goals can drive transformative change, help us manage and track progress, and create accountability for measurable improvement," said HHS Secretary Sylvia Burwell.
The clock is ticking on clinical quality improvement. If hospitals and practices want to be paid in the years to come, it's incumbent on them to show they're delivering better care.
"Provider organizations are under this increasing imperative to move the needle on high-priority targets as we shift from volume to value," says Jerry Osheroff, MD, a former chief clinical informatics officer and the founder of TMIT Consulting, which seeks to help providers, vendors and other stakeholders improve processes and outcomes.
"What does 'value' mean? It means taking care of chronic disease, taking care of acute disease, not causing unnecessary harm," he says. "There's now measures associated with all these things, and performance on those measures is driving reimbursement. Having care delivery be efficient and effective is no longer a nice-to-do, which it's been for many decades. It's now a gotta-do."
Osheroff is also editor-in-chief of HIMSS' award-winning guidebooks on clinical decision support. And CDS, he says, is a crucial component in helping providers get to where they need to go with their quality improvement projects.
But a proper understanding of what CDS is (hint: it's not about EHR alerts) and how to approach it (people come first!) is essential.
Help wanted
In his just-published HIMSS book on clinical informatics, Ken Ong, MD, chief medical informatics officer of New York Hospital Queens, illustrates just how important CDS tools and processes are to modern practice.
To take just one example: The number of medical journal articles has quadrupled from 200,000 in 1970 to more than 800,000 in 2010, Ong points out: "With the current number of articles published annually in medical literature, a recent medical school graduate who reads two articles every day would be 1,225 years behind at the end of the first year."
Indeed, "if a physician followed all the recommendations from national clinical care guidelines for preventive services and chronic disease management and added the time needed to answer phone calls, write prescriptions, read laboratory and radiology results and perform other tasks for a typical patient panel of 2,500, he or she would need 21.7 hours per day," he writes. "Information overload coupled with a paucity of time suggest the value of CDS and greater team-based care."
Clinical decision support tools are myriad and varied.
"The most frequently cited example of CDS is a drug-allergy interaction alert to a physician at time of order entry," Ong writes. "Drug-drug, drug-allergy and drug-food interaction alerts are indeed prototypical examples of CDS, but there are other tools in the CDS toolbox. Each CDS intervention can have a different use case, target audience and fit in a particular point in the clinical workflow."
The book offers a long list of examples: alerts and reminders; clinical guidelines; clinician patient assessment forms; data flow sheets; documentation templates; infobuttons; order facilitators (order sets, order consequents, order modifiers); patient data reports and dashboards; protocol/pathway support; task assistants; tracking and management systems.
But the optimal approach to clinical decision support should not be focused primarily – or even secondarily – on technology.
"This work is about people, processes and technology – in that order," says Gregory Paulson, deputy director of programs and operations at Trenton Health Team.
There is a great deal more found at this link. It’s a long and useful article!
The scope of the CDS domain is now huge and growing. Well worth a read.
David.

1 comment:

Bernard Robertson-Dunn said...

Hurrah,

" "We believe these goals can drive transformative change, help us manage and track progress, and create accountability for measurable improvement," said HHS Secretary Sylvia Burwell.

The clock is ticking on clinical quality improvement. If hospitals and practices want to be paid in the years to come, it's incumbent on them to show they're delivering better care."

Now that's what I was talking about the other day. Real eHealth, not dumb technology driven databases that will cause more problems than they solve.

And on that subject, have a look at
http://www.ibac.vic.gov.au/docs/default-source/intelligence-reports/organised-crime-group-cultivation-of-public-sector-employees.pdf

If the government thinks that the PCEHR won't be attractive to crims, then I think they are being naive.

So what's Australia doing in this area?