CMS Warns Against Relying Too Heavily On EHRs

By Christine Kern, contributing writer

“Pop-up” alerts are an important tool in EHR MU, but not the only one.

Don’t rely too heavily on clinical decision support (CDS) “pop-up” alerts when meeting Meaningful Use Stage 2 objectives, warns the CMS.

As medical data and individual patient information become more readily available electronically, CDS is meant to improve quality of care and enhance outcomes by avoiding errors and adverse events, improving efficiencies, and reducing costs all while enhancing provider and patient satisfaction. It is being identified as a keystone for enabling the effective use of the copious patient data being generated from medical devices and electronic health records.

Bradley Merrill Thompson, general counsel for the CDS Coalition, which represents software providers, healthcare payers, providers, and medical device manufacturers, explains, “This is one of the main drivers for the popularity of CDS. For the next stage of meaningful use, healthcare providers using electronic health records will need to incorporate more and more CDS into their software to qualify for incentive payments.”

The CMS defines CDS as “HIT functionality that builds upon the foundation of an EHR to provide persons involved in care processes with general and person-specific information, intelligently filtered and organized, at appropriate times, to enhance health and health care.”

During Stage 1 of MU, eligible professionals and hospitals must implement one CDS rule. During Stage 2, however, they must implement five CDS interventions related to four or more clinical quality measures and implement functionality for drug-drug and drug-allergy interaction.

According to CMS, CDS can be provided in several ways, including interruptive activities such as “pop-up” alerts, information displays or links (such as InfoButton), and targeted highlighting of relevant data. However, the guidance warns, “While many providers may associate CDS with pop-up alerts, alerts are not the only or necessarily the best method of providing support.”

“For example, a pop-up alert can only fire ‘after’ an event has occurred (e.g., a provider has ordered a contraindicated medication),” the guidance continues. Since “pop-up” alerts are not universally effective for improving outcomes, CMS encourages the use of CDS interventions that are not “pop-up” oriented.

“Although the trigger intervention certification criteria require EHR technology to produce an alert at relevant points during patient care, the meaningful use objectives give providers flexibility in the types of CDS interventions they employ, and do not limit them to ‘pop-up’ alert interventions,” states CMS in the guidance on CDS interventions. “Providers can meet the objectives by using other kinds of CDS, including, but not limited to: clinical guidelines, condition-specific order sets, focused patient data reports and summaries, documentation templates, diagnostic support, and contextually relevant reference information.”

The CMS states that the crucial aspect of CDS use is that critical information be presented at the appropriate time, to those who can act on the information, and in a way that supports completion of the right action.

For more information, click on CMS’ recently updated Clinical Decision Support tipsheet and a new FAQ.