Meaningful Use

Hospitals Advised to Be Thorough When Deploying Clinical Decision Support Tools

By Leslie Feldman

Evidence-based alerts are viewed as a primary way of improving care

HealthEast Care System has nearly 600 order sets in its computerized provider order entry system. Nearly 250 of those are evidence-based and contain some form of clinical decision support.

In many ways, the St. Paul, Minn., system seems well positioned to meet the definition of meaningful use of an electronic health record, which is expected to be released in late spring or early summer. The proposed rule published in January suggests that hospitals implement a minimum of five clinical decision support rules in their EHRs. Few expect the Centers for Medicare & Medicaid Services to dampen that requirement significantly in the final regulation.

"HealthEast is fully committed to achieving meaningful use at all three of our eligible [short-term acute care] hospitals," says Brian Patty, M.D., chief medical information officer. "The criteria for meaningful use are very much in alignment with our overall objectives in deploying our EHR: improving patient care through compliance with evidence-based best practices."

But building evidence-based decision support tools into an EHR isn't a simple task, nor is getting physicians to adhere to the alerts.

Gail Keenan, R.N., chair of the American Medical Informatic Association's clinical information system's working group and director of the Nursing Informatics Initiative in the College of Nursing at the University of Illinois Chicago, doesn't think most clinical decision support tools today meet clinicians' needs because they haven't been rigorously tested in real-world scenarios. She says the "know-how exists to build simple to highly sophisticated CDS" that can consolidate and present actionable information to clinicians, but that won't happen without the demand and the resources to test and validate performance.

"The requirement to create clinical decision support rules is a good step toward using systems to guide physicians," explains Scott Weingarten, M.D., president and CEO of Zynx Health, a company providing evidence-based and experience-based clinical decision support solutions. "I think the bar is still very low for clinical support rules. In order to get the clinical return on investment and the cost benefits that the federal government would like to achieve, I think they're going to need more than five, but I think it's a good start."

Sean Benson, co-founder and vice president of consulting at ProVation Medical, part of Wolters Kluwer Health, adds that effective use of clinical decision support can have a positive impact on the bottom line. "CDS can reduce the costs associated with medical errors and adverse events, which in turn enables hospitals to provide better care to more patients at lower prices," he says.

This article 1st appeared in the May 2010 issue of HHN Magazine.

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