Clinical Decision Support Systems in Healthcare

Clinical Decision Support Systems in Healthcare Melchor Abejon One pressing public health problem and a threat to patient safety are medical errors. Written articles about such incidents have highlighted cases and the amount of money spent. According to the United States (US) News and World Report (2013), medical error is the third leading cause of death in the US after heart disease and cancer with an estimate number of 250,000 deaths annually. Clinical decision making in healthcare is a very crucial process. Though this process will always be flawed, for sure there are ways to make it better. With the advent of the Electronic Health Record (EHR) meaningful use incentive program and the development of Clinical Decision Support (CDS) tools, healthcare organizations along with clinicians are mandated to integrate CDS into their federally certified EHR systems. As the director of clinical decision support at a healthcare delivery system, the purpose of this paper is to: Describe the different approaches to be used that will ensure all aspects of patient care are considered in the development of a CDS system. Identify how the efforts of the CDS team would be prioritized in the development of CDS in the organizations focus areas. Approaches to Developing a CDS System Like in the implementation of any other health information systems, the development and implementation of a CDS system entails an equivalent complexity and hard work. It is an endeavor that requires significant planning and preparation.ÂÂ   Once implemented, it is essential to evaluate and measure its value as an additional asset of the organization. According to Nelson and Staggers (2014), the CDS as a valuable tool can prevent many clinical errors especially when coupled with a computerized information system that enables process improvement measures. Though it is mentioned in the given scenario that the organization has existing CDS, my plan is to re-evaluate the existing systems and processes, and I want to make sure that I would not be missing a single essential step in my project, and have everything taken into consideration as I create a new plan.ÂÂ   Health IT provides a systematic strategic plan for the implementation of CDS which I will adopt for the organization. The strategic plan is composed of five steps as listed and described below: Commence the project with a strong foundation. This initial step includes assessing the readiness of the organization to adopt a CDS intervention; assessing the interest of stakeholders in using CDS to improve outcomes, and as well as assessing the overall capacity of the organization to adapt to the change. My key steps to establishing a strong project foundation are: To identify the essential stakeholders who can contribute to a discussion about using CDS to improve the quality and safety goals of the organization. To establish goals for the CDS by collaborating with the stakeholders to highlight the benefits and barriers to implementation. To determine the readiness of the organization for a CDS initiative. This is a critical process. A key aspect of readiness is understanding how well the organization can adapt to the change. To develop a plan on how to proceed with the implementation. It includes identifying the core members of the implementation team, outlining and refining achievable quality goals, identifying strategic next steps toward achieving the goals, building a shared vision among the stakeholders, and identifying champions of the project. Assemble a CDS implementation team.ÂÂ   My key steps to assembling the implementation team are: To stress the roles of the stakeholders that are required for the success of the project. To seek a clinical champion who possesses the desired characteristics for the role. To collaborate with an outside source who may be able to assist and fill the gaps in expertise in the implementation of CDS. To call for the implementation team to start planning by holding a kick-off meeting. Plan for successful development of CDS, design and deployment. The following are my key steps to assist the organization achieve the capacity for CDS interventions: To select a clinical goal that suits best to the goals and needs of the organization. The end users should agree with the chosen goal. To consult Electronic Medical Record (EMR) vendors and designers about ways on how CDS can help improve the clinical goals and objectives of the organization. It is important to discuss with them and determine the ability of a given CDS intervention to be customized to support the needs of the end-users. To select a CDS intervention that can help achieve the clinical goals and objectives of the organization. Considerations are ease of implementation, effect on clinical quality reporting, implementation of financial incentives, and workflow. To develop clinical objectives and baseline measures for the goals to help measure improvements. Example of this is through the utilization of metrics to measure baseline performance and assess the effect of the intervention. To map out existing workflows and clinical processes affected by the interventions. To develop a system for keeping interventions and CDS clinical knowledge current. This includes identifying people and processes that are involved in the interventions update. To ensure the usability of the CDS intervention by understanding its limits of functionality and possibly request for customization if needed. To test for the CDS interventions usability and effect on workflows. Roll out effective CDS interventions. My key steps are: To create a roll out plan. This includes defining the clinical goals and having the selected interventions assessed and tested. Also, to determine how to implement the interventions in the best way. To communicate the roll out plan to the end-users and stakeholders. This can be accomplished by describing and disseminating to the stakeholders the expected changes to the organizations workflow and processes. To develop a training plan to train users with the new intervention. To ensure that support structures such as people and other resources are in place to provide support during and after deployment of the intervention. Measure the effects of the intervention. This pertains to measuring the impact of the intervention post-implementation and to ensure it is improving the organizations processes and outcomes, and that clinical goals and objectives are being met. My key steps are: To conduct an ongoing assessment of the CDS systems usability. This includes capturing feedback and assessing how well is the intervention being received by the end-users. To collect and report the performance of the intervention against the clinical goals and objectives. To use feedback and measurement results to continually improve the performance of the intervention. To have the end-users get involved in the refinement of the intervention by communicating back to them the changes and by showing them continued support. Bates et al. (2003) published the Ten Commandments for effective Clinical Decision Support Systems (CDSS). This is another important collective approach and consideration in developing and implementing a CDSS for the organization. Listed below are the ten commandments for CDSS: Speed is everything. Speed is what end-users value most and is a top priority. Anticipate needs and deliver in real time. Information should be delivered when needed. Fit into the users workflow. Suggestions are integrated with clinical practice. Little things can make a big difference. In order to do the right things, usability of the intervention should be improved. Recognize that physicians will strongly resist stopping. Rather than insist on stopping, alternatives should be offered. Changing direction is easier than stopping. Example is changing dose defaults; route or medication frequency can change behavior. Simple interventions work best. Guidelines can be simplified by reducing to a single computer screen. Additional information can be asked when you really need it. A guideline will less likely be implemented when more data elements are requested. Monitor impact, get feedback and respond. If some reminders are not followed, either readjust or completely remove the reminder. Maintain and manage the knowledge -bases system. Information and currency of information should be monitored. CDSS Team Efforts and Areas of Focus Payment rates tied to quality measures. A primary consideration when developing and implementing a CDSS is the cost savings for the total system. With the existing reimbursement scheme, the financial commitment to implement a CDSS has become one major consideration to many health care organizations. Insufficient documentation of patients diagnosis has always been the difficulty in maximizing and meeting compliance with reimbursement and external quality agencies. As the director of the clinical decision support, I will summon and coordinate with the team to create a CDS intervention that can improve compliance with billing directives by ensuring systems work harmoniously to capture the correct diagnosis. Having such efficient CDSS in harmonious work with the organizations information systems can ensure delivered care, coded care, and documented care to become the same, thus meeting the meaningful use criteria and aligning with the nations health outcome policy priorities. CDS interventions that meet meaningful use. The stage 2 of the EHR meaningful use requires hospitals and healthcare professionals to implement five CDS interventions that are directly linked to four or more of the Center for Medicare and Medicaid Services (CMS) quality measures. As the leader of the team, I will suggest and work with the team on the implementation of support measures that will monitor health conditions that are of high priority such as stroke, hypertension, cancer and diabetes. Also, the team will aim to develop a CDS intervention that will alert clinicians when a patient is a candidate for colorectal screening. This intervention directly corresponds with the NQF-0034 colorectal cancer screening clinical quality measure. Also, the team will ensure that the CDSS will meet meaningful use by considering the five rights of CDS which are (a) the right information, (b) to the right person, (c) in the right format of intervention, (d) through the right channel, (e) at the r ight time in workflow (Campbell, R., 2016). CDSS in appropriate care services such as congestive heart failure. The team will consider developing a CDS intervention that will assist providers adhere to medical care, practice guidelines and prescribing guidelines. The administration of B-blockers has been demonstrated effective in improving the chance of survival for heart failure patients. The deployment of electronic reminder interventions for the prescription of drugs and appropriate dosing can additionally improve the care and survival for congestive heart failure patients and also in the management of chronic diseases. Other areas for clinical improvement. CDSS has also been proven effective in preventive service processes. As the leader of the team, I will work with the team to implement computer-generated reminders for providers to improve the standard of care in preventive services such as hypertension and smoking cessation counseling, eye and diabetic foot examinations, measurement of lipid levels, and glycosylated hemoglobin and proteinuria testing for diabetic patients. Conclusion The CDSS when coupled with the organizations existing systems such as the EHR and Computerized Provider Order Entry (CPOE) can work harmoniously to provide an effective clinical decision support to improve the quality of care in a healthcare organization. Though challenges may seem formidable, coming up with an effective approach in the development and implementation of such systems can assure positive return in investment overtime. References Bates, D. W. et. al (2003). Ten commandments for effective clinical decision support: Making the practice of evidence-based medicine a reality. Retrieved January 29, 2017 from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC264429/ Campbell, R. (2016). The five rights of clinical decision support. CDS tools helpful for meaningful use. Retrieved January 29, 2017 from http://bok.ahima.org/doc?oid=300027#.WJC59_krLIV Gross, P.A., Bates, D.W. (2007). A pragmatic approach to implementing best practices for clinical decision support systems in computerized provider order entry systems. Retrieved January 29, 2017 from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2215068/#bib13 HealthIT.gov (n.d.). How-to guides for clinical decision support implementation. Retrieved January 29, 2017 from https://www.healthit.gov/policy-researchers-implementers/cds-implementation Murphy, E.V. (2014). Clinical decision support: Effectiveness in improving quality processes and clinical outcomes and factors that may influence success. Retrieved January 29, 2017 from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4031792/ Nelson, R., Staggers, N. (2014). Health informatics: An interprofessional approach. (1st Ed.). St. Louis, MO; Elsevier Mosby United States News and World Report (2016). Medical errors are third leading cause of death in the U.S. Retrieved January 29, 2017 from http://www.usnews.com/news/articles/2016-05-03/medical-errors-are-third-leading-cause-of-death-in-the-us