Achieving Meaningful Clinical Decision Support in a Medical Home JEROME A OSHEROFF, MD, FACP, FACMI CHIEF CLINICAL INFORMATICS OFFICER, THOMSON REUTERS.

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Presentation transcript:

Achieving Meaningful Clinical Decision Support in a Medical Home JEROME A OSHEROFF, MD, FACP, FACMI CHIEF CLINICAL INFORMATICS OFFICER, THOMSON REUTERS FACULTY/STAFF, UNIVERSITY OF PENNSYLVANIA PCPCC Conference March 30, 2010

©2009 Thomson Reuters PCMH & CDS: MEANS TO AN END Measurably Improve Quality/Safety/Cost/ Efficiency/Satisfaction Accreditation Reimbursement –Value-based Purchasing/non-payment –Transparency/Accountability –Meaningful Use Drivers are Intensifying and Consolidating!

©2009 Thomson Reuters “QUALITY/SAFETY” TARGETS* 3 * From meaningful use NPRM

©2009 Thomson Reuters EHR ≠ QUALITY

©2009 Thomson Reuters PERFORMANCE IMPROVEMENT: A SYSTEMATIC APPROACH Select/ Prioritize Targets (MU/Analytics) Measure Baselines, Benchmark Develop Improvement Plans Execute Improvements (CDS) Re-measure 5

©2009 Thomson Reuters CDS DEFINITION 6 “…provide persons involved in care processes with general and person- specific information, intelligently filtered and organized, at appropriate times, to enhance health and health care” – from MU NPRM  Includes/builds on current processes…  NOT just rules and alerts…

©2009 Thomson Reuters GUIDANCE ON GETTING CDS RIGHT Co-published 4/09 by leading societies; ~100 contributors 2009 HIT book of the year Co-sponsors include AHRQ, 3 CIS vendors “This is not a book” 2005 HIT book of the year All-time HIMSS bestseller Widely used by CMIOs/others 10 commandments for CDS: Bates et al. JAMIA 2003 CDS: the road ahead. Greenes ed. Elsevier 2007 HIMSS Others

©2009 Thomson Reuters A FORMULA FOR SUCCESS: THE CDS FIVE RIGHTS To improve care outcomes with CDS you must provide: the Right Information… Evidence-based, useful for guiding action and answering questions …to the Right Stakeholder… Both clinicians and patients …in the Right Format… Alerts, Order Sets, answers, etc. …through the Right Channel… Internet, mobile devices, clinical information systems …at the Right Point in the Workflow to influence key decisions/actions

©2009 Thomson Reuters 9 CDS INTERVENTION TYPES Relevant data presentation: flowsheets, surveillance Order creation facilitators: order sentences, sets Reference information: infobuttons, Web Unsolicited alerts: proactive warnings Documentation templates: patient history, visit note Protocol support: pathways

©2009 Thomson Reuters Workflow Opportunities

©2009 Thomson Reuters CDS PEARLS FOR MEDICAL HOMES 1. Consider CDS Basics –Define CDS broadly –Consider CDS 5 Rights 2. Establish Foundation –Select/prioritize targets –Establish baselines 3. Consider Workflow 4. Optimize CDS in Available Systems –EHR, Portal, Registry, Practice Management…

©2009 Thomson Reuters CDS PEARLS FOR MEDICAL HOMES 5. Optimize CDS for Specific Targets –Workflow analysis/CDS 5 Rights=alert fatigue antidote 6. Deploy for Max Acceptance & Value –Fully engage staff/patients 7. Measure Effects and Refine Program –Do it! (Examine intended/unintended effects; enhance) 8. Manage Knowledge Assets/Processes –Approach proactively, systematically

©2009 Thomson Reuters THANK YOU! Resources PCPCC –Meaningful Use Meaningful Connections: HIMSS Clinical Decision Support Guides – HIMSS CDS Task Force (VTE and Meaningful Use Projects) – Jerry Osheroff