Clinical Decision Support – Getting the Focus it Needs.

The following appeared a few days ago.

AMDIS members target clinical decision support

By: Joseph Conn / HITS staff writer

Story posted: August 8, 2008 - 5:59 am EDT

Members of the Association of Medical Directors of Information Systems at their convention last month vowed to take up the challenge of creating a collaborative environment for the gathering and sharing of best practices for clinical decision support, or CDS, drawing on their breadth of experience in the practical application of medical informatics.

For a majority of attendees at the 17th annual AMDIS Physician-Computer Connection Symposium at Ojai, Calif., implementing clinical information systems is no longer their biggest problem, but optimizing CDS tools for use in conjunction with those systems is.

Jerome Osheroff, chief clinical informatics officer with the Ann Arbor, Mich.-based healthcare unit of information broker Thomson Reuters, gave a call to arms, saying that members need to take a leadership role in developing CDS systems, and that's not only because as physician informaticists they are best-positioned to do so. A potential tsunami of outside influences—including pay-for-performance mandates and non payment penalties for medical errors, employer and patient pressures for quantifiable quality improvement gains and accreditation requirements—will force them to have the systems producing clinical and financial results, Osheroff said.

In an interview this week, AMDIS Chairman William Bria said that CDS has been a hot topic on the organization's listserv and work on a white paper "is going extremely well."

"The outpouring of interest in doing a white paper and communicating at the highest levels is overwhelming," Bria said. "I think everybody is willing to tell the story about physician leadership about CDS." He said Harris Stutman, executive director of clinical informatics at MemorialCare health system, Long Beach, Calif., will be heading up the group working on the AMDIS white paper on CDS and the role of the chief medical information officer.

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Massachusetts Blue Cross and Blue Shield announced last year it will require hospitals to have computerized physician order-entry systems by 2012 as a condition of participation in its incentive program. But those hospitals will have to battle with what Bria and others have called a "misalignment of incentives" in that they incur the expense of implementing and maintaining a CPOE system with decision-support capabilities, but the financial benefits accrue to the patient and the payer.

"A lot of these hospitals are working on razor-thin margins," he said. "If you implement things that will make people less efficient, even for a little while, you're going to lose money."

Bria said the white paper could be published in 90 days or so.

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Osheroff said CDS provides clinicians or patients with clinical knowledge and patient-related information that's been intelligently filtered or presented at appropriate time. There are, he said, five "rights" of CDS:

• Having the right, evidence-based information.
• Having that information delivered to the right person, whether they be a clinician or patient.
• Having the information delivered in the right intervention format, whether it be a paper document, a computer-based alert, an appropriate order set or some other form.
• Having the information delivered through the right communications channel, such as the Internet or mobile phone.
• Having the information at the right point in the workflow.

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Osheroff is the editor-in-chief of a new soon-to-be released book, Improving Medication Use and Outcomes with Clinical Decision Support: A Step-By-Step Guide.

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The full article is accessible here (after registration)

http://www.modernhealthcare.com/apps/pbcs.dll/article?AID=/20080808/REG/360675982/1029/FREE

This seems to me to be a very important change in perspective and emphasis. To date the transfer of CDS from the expert leading hospital sites has really met with quite mixed success. There is no doubt the need for CDS is very real and that the basic theory is sound. What is now needed is the engineering of solutions that actually work well in the real world of the delivery of clinical care in routine situations.

As acknowledged in this article we are still a way from this situation at present. Given the potential for good in terms of quality of care and patient safety this problem needs to be addressed as a matter of considerable priority!

David.