So You Want to Do CDS A C-Level Introduction to Clinical Decision Support.
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Transcript of So You Want to Do CDS A C-Level Introduction to Clinical Decision Support.
So You Want to Do CDS
A C-Level Introduction toClinical 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 errorsReduced dosing errors after implementing CDS with CPOE
0
0.5
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1.5
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2.5
Pre-OE Post-OE Year 1 Year 2 Year 3
% o
f or
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Teich JM, Merchia PR, Schmiz JL, Kuperman GJ, Spurr CD, Bates DW. Effects of physician order entry on prescribing practices. Arch Int. Med. 2000 Oct 9;160(18):2741-7
CDS can improve adoption of best practices Use of recommended H2 blocker before and after CPOE
0102030405060708090
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-7 -6 -5 -4 -3 -2 -1 0 1 2 3 4 5 6 7 8
Week
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f o
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Teich JM, Merchia PR, Schmiz JL, Kuperman GJ, Spurr CD, Bates DW. Effects of physician order entry on prescribing practices. Arch Int. Med. 2000 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 criticalDavies 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
FOR MORE INFORMATION
HIMSS CDS Web Site:
http://www.himss.org/ASP/topics_clinicalDecision.asp