Decision support integrates evidence-based medicine

Key Points

BENDING THE COST CURVE is still the mantra in the healthcare industry. But at the same time, payers and providers are seeking increased care quality. Keeping people healthy in the first place, identifying diseases early and comprehensive follow-up care after a hospitalization are all seen as methods to reduce costs and improve quality.

"Decision support can be a challenge to implement," says Harry Greenspun, MD, senior advisor for healthcare transformation and technology, Deloitte Center for Health Solutions. "The slow adoption of electronic health records means that the power to harness decision support has been limited."

Deloitte recently reported findings from interviews with executives about the activities and attitudes regarding IT and data management. The report stratified respondents into three groups based on their priorities for achieving meaningful use, ICD-10 conversion, data aggregation and analytics and other informatics issues.

Those further along the adoption curve are more likely to have developed or are in the process of developing clinical decision-support tools. Those at the beginning of the EHR adoption curve, however, view decision support as a longer term goal.

The degree of integration and interoperability of a hospital or healthcare system's IT infrastructure can influence the effectiveness of decision-support tools, Dr. Greenspun says. But some organizations ignore important workflow and cultural changes that must occur in order to leverage these tools fully.

"Decision support must become part of what [practitioners] do," Dr. Greenspun says. "It potentially involves changing workflows and processes, because if you don't have the data at the right time and in the right place, decision support will be difficult to use."

Unity Health System implemented an EHR system in 2003 among its ambulatory offices and in 2006 in its hospital facility. The system, which serves Rochester, N.Y., and Monroe County, current has achieved HIMSS Level 4 status, which comprises computerized physician order entry (CPOE) and the use of a clinical decision-support system, says Margaret Donahue, MD, chief medical information officer.

The CPOE system includes a knowledge base of medications, drug allergies and drug-to-drug interactions. Order sets at the point of care are based on evidence and standards of care for each condition.

One potential failing of clinical decision support is the overuse of alerts, which can condition staff to ignore them or turn them off.

"Whenever you implement a system, you should have clinical decision support turned on for drug interactions," Dr. Donahue says. "It's a process of evaluation from there."

Out-of-the-box solutions tend to be conservative, so some customization is advisable on the front end, she says. She has a team that assesses alerts, how often they're overridden and why. The goal is to disable alerts that are redundant or lack practical value, while conducting training to ensure the important reminders receive attention.