Evidence-based clinical support sounds great on paper. The concept of using the current best evidence derived from high-quality research to make better informed clinical decisions seems like a no-brainer.
Yet, in practice, adoption of the approach is often easier said than done. Those challenges were highlighted recently in Chicago at a Charter of the Institute for Medicine Roundtable, “Transforming Healthcare Through Evidence- Based Medicine.” There, panelists discussed how healthcare organizations “struggle with how to communicate the benefits, function, scope, and value of evidence-based medicine to physicians, patients, policy makers, and payors.”
Yet, some healthcare organizations are making considerable strides on the path toward deeper integration and adoption of the practice. Cleveland, OH-based MetroHealth System has made evidence-based clinical decision support (CDS) a central part of its focus on enhancing patient care. Jill Evans, RN, MSN, clinical informatics manager, shared her insight on MetroHealth’s efforts to bridge the gap between knowledge and practice of evidence-based clinical decision support.
By Scott Westcott, Contributing Writer
Cleveland’s MetroHealth System is on a multiyear journey to encourage physician adoption of evidence-based clinical decision support to deliver care more efficiently and effectively.
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Evidence-based clinical support sounds great on paper. The concept of using the current best evidence derived from high-quality research to make better informed clinical decisions seems like a no-brainer.
Yet, in practice, adoption of the approach is often easier said than done. Those challenges were highlighted recently in Chicago at a Charter of the Institute for Medicine Roundtable, “Transforming Healthcare Through Evidence- Based Medicine.” There, panelists discussed how healthcare organizations “struggle with how to communicate the benefits, function, scope, and value of evidence-based medicine to physicians, patients, policy makers, and payors.”
Yet, some healthcare organizations are making considerable strides on the path toward deeper integration and adoption of the practice. Cleveland, OH-based MetroHealth System has made evidence-based clinical decision support (CDS) a central part of its focus on enhancing patient care. Jill Evans, RN, MSN, clinical informatics manager, shared her insight on MetroHealth’s efforts to bridge the gap between knowledge and practice of evidence-based clinical decision support.
Q: What value does MetroHealth place on evidence-based clinical decision support?
A: Our vision is to be the most admired public health system in the country. Thus, we strive to be in the top decile for quality measures in the country. We’re known for our high-value, ![]()
top-notch, cost-effective care. We believe that widely deploying and utilizing evidence-based clinical decision support is a key technology component to achieving these goals.
Q: What prompted MetroHealth to further its efforts in this area by implementing an evidence-based order-set solution?
A: We had developed and built our own order sets as part of our inpatient electronic health record deployment in the summer of 2009. At that time, we set an internal goal of reviewing these order sets every two years. By the summer of 2011, after we had reviewed only three of these order sets ourselves, we knew we needed help. We decided to implement ProVation evidence-based order-set templates from Wolters Kluwer Health. ProVation, by itself and through its partnership with UpToDate, provided the framework, tools, knowledge, and content so that we could efficiently and effectively manage our inpatient order sets. The fact that only one-third of order sets have practice-changing content changes on an annual basis means that it’s cost-effective to have a third party identify this subset. This way, local resources know the subset of orders that need updating, as opposed to spending our resources reviewing each and every order set.
Q: What benefits does the solution provide your health system, clinicians, and patients?
A: Having evidence-based content, links, and narratives within our order sets provides our organization and providers with the most up-to-date best practices for patient care. This content can help guide physicians through order entry ensuring that they meet regulatory, quality, and Meaningful Use measures.
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The implementation of evidence-based order sets provides our patients with the best quality care. With so much emphasis being placed on quality care, core measures, and Meaningful Use, we are able to ensure our patients are getting the proper care by incorporating those measures directly within the order set. This ensures that physicians order preoperative antibiotics to meet Surgical Care Improvement Project (SCIP) measures, get the right venous thromboembolism (VTE) prophylactics based on patient risk to meet VTE core measures, and provide the ventilated patient with the proper orders to prevent ventilator-associated pneumonia (VAP). Anything we can do to make sure a patient has the best clinical outcome is the main goal here, and evidence-based order sets are one piece of the puzzle.
Q: How does MetroHealth encourage clinician adoption of these evidence-based order sets?
A: The project team reached out to the organization’s physician leadership within each department to designate physician representatives to work with the project team to review and finalize content and to link information and narratives. Physician participation has been a key component to helping push our message and encourage evidence-based order-set usage. MetroHealth has been on CPOE (computerized physician order entry) since 2009, so we designed the new evidence-based order set to include any of our old order set’s naming conventions and numbering as a synonym within Epic (MetroHealth’s EHR system). This way, when the physician searches for an order set, Epic will suggest the new evidence-based version.
Q: What strategies do you deploy to increase buy-in from physicians?
A: We continue to work on getting the message out to our physicians. We are investigating the best way to “suggest” an order set to our physician teams within Epic, based on a patient’s diagnosis. One other step we have taken is to publish on our internal website monthly announcements on newly available order sets and the prior month’s usage rates. The project leaders report progress monthly to an executive committee and have the committee’s full support in mitigating any issues. Having executive support on the project has been instrumental as it has helped encourage participation and the overall project’s importance to the organization.
Q: As a result, how have your clinicians taken to the solution? What results/outcomes have you seen to date?
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A: We are still working to completely build out all of our evidence-based order sets. The project team is tracking usage, and it is our expectation that by incorporating evidence-based order sets to drive practice, we will see improved quality data and shorter lengths of stay.
Q: Do you have any plans to further your use of evidence-based CDS in your health system?
A: This current project encompasses only the inpatient and clinical decision areas of the hospital. No plans have been discussed to move the project to outpatient sets, but significant improvements in our inpatient quality of care and performance measures would encourage the project’s spread to other areas of our organization.
Q: What CDS best practices or lessons learned would you share with other providers based on your experience?
A: One of the biggest benefits for us has been the support we’ve received from executive leadership. It has been instrumental in removing barriers and encouraging participation. We have been very fortunate to have participants from all areas of the organization, including physicians, administrators, clinical nurse specialists, and pharmacists. All areas participate in creating and revising our order sets to ensure that we are guiding the highest-quality care for our patients. A team effort makes it all work.
Evidence-based clinical support sounds great on paper. The concept of using the current best evidence derived from high-quality research to make better informed clinical decisions seems like a no-brainer.
top-notch, cost-effective care. We believe that widely deploying and utilizing evidence-based clinical decision support is a key technology component to achieving these goals.
The implementation of evidence-based order sets provides our patients with the best quality care. With so much emphasis being placed on quality care, core measures, and Meaningful Use, we are able to ensure our patients are getting the proper care by incorporating those measures directly within the order set. This ensures that physicians order preoperative antibiotics to meet Surgical Care Improvement Project (SCIP) measures, get the right venous thromboembolism (VTE) prophylactics based on patient risk to meet VTE core measures, and provide the ventilated patient with the proper orders to prevent ventilator-associated pneumonia (VAP). Anything we can do to make sure a patient has the best clinical outcome is the main goal here, and evidence-based order sets are one piece of the puzzle.
A: We are still working to completely build out all of our evidence-based order sets. The project team is tracking usage, and it is our expectation that by incorporating evidence-based order sets to drive practice, we will see improved quality data and shorter lengths of stay.
