So You Want to Do CDS A C-Level Introduction to Clinical Decision Support

What is Clinical Decision Support (CDS)? Clinical decision support is a process for enhancing health-related decisions and actions with pertinent, organized clinical knowledge and patient information, to improve health and healthcare delivery. Source: Improving Outcomes with CDS: An Implementer’s Guide, HIMSS 2011

The Components of CDS Information recipients ‑ Include patients, clinicians and others involved in patient care delivery Information delivered ‑ Include general clinical knowledge and guidance, intelligently processed patient data, or a mixture of both Information delivery formats ‑ Drawn from a rich palette of options that includes data and order entry facilitators, filtered data displays, reference information, alerts, and others. Source: Improving Outcomes with CDS: An Implementer’s Guide, HIMSS 2011

Like a GPS, CDS supplies information tailored to the current situation, and organized for maximum value.

A simple and classic CDS example: Drug warnings

A More Elaborate CDS Example: Order Sets

Types of CDS Drug-Drug Interactions Drug-Allergy interactions Dose Range Checking Pick lists Standardized evidence based order sets Links to knowledge references Links to local policies Alerts Rules to meet strategic objectives (core measures, antibiotic usage, blood management) Documentation templates Relevant data displays Point of care reference information (i.e. InfoButtons) Web based reference information Diagnostic decision support tools

CDS is a Strategic Tool CDS is a strategic tool for achieving an organizations priority care delivery objectives. ‑ Some objectives are driven by external forces such as payment models and regulations related to improving care quality and safety ‑ Other objectives are driven by internal needs for improving quality and patient safety, reducing medical errors, increasing efficiency and other performance enhancements.

Examples of The Value of CDS Quality ‑ By guiding users to best practices Safety ‑ By verifying an action was the intended one Cost ‑ Catching duplicate or unnecessary orders Documentation ‑ By bringing forth documentation tools based on a diagnosis or problem Communication ‑ Of system priorities or initiatives ‑ Among providers of patient status

CDS can reduce errors Reduced dosing errors after implementing CDS with CPOE Teich JM, Merchia PR, Schmiz JL, Kuperman GJ, Spurr CD, Bates DW. Effects of physician order entry on prescribing practices. Arch Int. Med Oct 9;160(18):2741-7

CDS can improve adoption of best practices Use of recommended H2 blocker before and after CPOE Teich JM, Merchia PR, Schmiz JL, Kuperman GJ, Spurr CD, Bates DW. Effects of physician order entry on prescribing practices. Arch Int. Med Oct 9;160(18):2741-7

Challenges of implementation Speed Usability and workflow Avoiding over-alerting Cultural change Management backing Clinical leadership backing

Need for Leadership Commitment CDS interventions impact workflow throughout an organization; therefore leadership at all levels must understand and support the efforts CDS programs require ongoing investment of capital and personnel A champion is required to be a change agent and lead the charge

CDS Does Not Make Policy CDS should not be thought of as the only tool available to solve the organization’s problems or communicate change. There are clear limitations to CDS interventions. When new policies or procedures are established, they should be thoroughly discussed by all relevant stakeholders before they appear in a CDS intervention.

Implementation skill is critical Davies winners assessment of amount of effort spent on design and implementation Design Implementation And once implemented, it must be maintained; an ongoing process

Ensuring a Successful CDS Program The value of the CDS to the organization must be consistently and continually communicated at all levels Close monitoring of all CDS must occur regularly to ensure validity. All efforts should be made to prevent alert fatigue. Successful CDS programs implement interventions WITH the stakeholders, and not TO the stakeholders CDS programs are a long-term commitment, must be prepared for the long haul Be prepared to deal with resistors and detractors, including the ability to answer any negative articles that appear in the literature Done well, it will help you improve the quality, safety and efficiency of the care you provide your patients while reducing your costs

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