BioPharma: Clinical Decision

HIT Perspectives Biopharma Insights – April 2014

Improving Adoption of Clinical Decision Support

By Brian Bamberger, Life Sciences Practice Lead

Use of effective clinical decision support (CDS) has been shown to improve health care quality – especially when enabled by electronic health records (EHRs) and integrated into ambulatory and acute care work flows. As such, increasing adoption of CDS was a focus of discussion at this year’s annual meeting of the Healthcare Information Management and Systems Society (HIMSS). (Click here for additional takeaways from HIMSS 2014 in HIT Perspectives.)

CDS includes a variety of techniques and data designed to facilitate and guide doctors’ decision making toward evidence-based practice. Adherence to CDS can improve quality of care, reduce costs and figure heavily in quality-based reimbursement and incentive programs.

HIMSS 2014 featured presentations by many health systems regarding their experiences in developing and using CDS, as well as barriers to its adoption. Most of the presentations for both inpatient and ambulatory systems included discussion of how entities were developing their own guidelines via literature searches and/or discussions with key physician leaders. One, in particular, showed the process used by one major health system to evaluate multiple studies – including those from competing organizations.It concluded that although CDS is based upon clinical evidence, often the algorithms used will be one-offs that are unique and specific to a hospital or practice.

While research suggests that CDS can be effective, its use is currently limited, as it is enabled disease by disease over a long period of time. According to the Agency for Healthcare Quality and Research (AHRQ), new and more effective health care treatment practices are not adopted quickly. Recent studies indicate an average of 17 years elapses before new knowledge generated through research becomes disseminated and is adopted into widespread clinical practice. Successful development and implementation of CDS programs can be delayed for a number of reasons, including:

  • Getting physician buy-in and participation in CDS development.
  • Ensuring development isn’t executed solely by a technical team.
  • Getting order sets that are set up specific to a particular pathway.
  • Overwhelming physicians who are new to EHR technology.
  • Developing triggers to identify the correct order set. With all the talk and documentation of alert fatigue, it’s easy to assume a new message will be overlooked.
  • Measuring results and exceptions can be challenging.

The slow adoption of CDS development can be related to the current state and use of EHRs. This was exemplified in a presentation by a major health system who is dissatisfied with its current EHR. Tempted to ‘rip and replace,’ this large integrated delivery network eventually decided to redouble efforts to configure its existing system with new documentation templates, order sets and triggers. Naturally, training also played a big part in this endeavor.

That health system is not alone. According to another survey, dissatisfaction with EHRs is widespread; one in four medical practices using EHRs is thinking about replacing its system. Usability issues, lack of capabilities to support value-based care and limited interoperability are fueling this dissatisfaction. Inadequate training, content, and availability also are problematic issues.

This atmosphere of dissatisfaction is not lost on government researchers and policy makers who are anxious for EHR (and CDS) adoption to continue increasing. For example, AHRQ recently funded its Clinical Decision Support Consortium to determine ways to improve CDS adoption and use. Details are available on the AHRQ web site.

Point-of-Care Partners (POCP) is helping its pharma and biotechnology clients understand what CDS is all about and where opportunities might lie in assisting health plans, accountable care organizations, and integrated delivery networks in developing CDS that is meaningful to their providers and quality goals.