Clinicians continue to face intensifying pressure from the growing number of tasks required in caring for patients. There is insufficient time to be confident that the care is comprehensive and adheres to contemporary standards. At the same time, studies evaluating clinical questions that arise in patient care have demonstrated that about two out of three patient encounters generate a question, of which only 40 percent are routinely answered. If all questions were answered, five to eight patient management decisions would be changed in each clinical session. By Denise S. Basow, M.D.
By Denise S. Basow, M.D.
Clinicians continue to face intensifying pressure from the growing number of tasks required in caring for patients. There is insufficient time to be confident that the care is comprehensive and adheres to contemporary standards.
At the same time, studies evaluating clinical questions that arise in patient care have demonstrated that about two out of three patient encounters generate a question, of which only 40 percent are routinely answered. If all questions were answered, five to eight patient management decisions would be changed in each clinical session.
The changes that result when clinical questions are answered are often substantive, altering diagnosis and treatment decisions and ultimately improving patient safety, efficiency and health outcomes. Thus, tools that can assist in assist in clinical decision-making have the potential to improve care.
The question then becomes how best to deliver those answers into clinicians’ hands when and where they’re most needed. Doing so effectively requires a strategic approach that takes into consideration clinician preferences and workflows, as well as an organization’s long-term health information technology (IT) plans.
Integrating CDS Into The Clinical Workflow
An important consideration for hospitals and other healthcare organizations is how to provide clinicians with rapid access to state-of-the-art, evidence-based guidance on current diagnostic and treatment approaches. Clinical decision support (CDS) can deliver relevant information that is trust-worthy, easily accessible, and helps clinicians deliver the best possible care.
CDS resources that are proven to be effective already exist. There are no substantial technological barriers to achieving a definitive and measurable benefit from their use. Today’s CDS tools can be accessed in a variety of ways, including mobile devices, and embedded within clinical or library portals or within health IT systems such as electronic medical records (EMR).
These details are critically important. CDS resources should ideally be tightly linked to clinical workflows, whether in an EMR system, mobile device or other access point. The user interfaces of both the CDS resource and the application through which it is access are also critically important; a slight change in the user interface within an EMR system, for example, can make the difference between no use and heavy use.
Mercy Health, one of the largest non-profit health systems in the U.S., has successfully deployed a proven CDS system, Wolters Kluwer Health UpToDate Anywhere. Mercy’s clinicians can access UpToDate on their mobile device, from any terminal in the hospital or clinic, at home or from within the EMR system.
Within the EMR, users can instantly find relevant guidance via an HL7 Infobutton. Integrating HL7 messaging at critical areas of the patient chart (problem list, health maintenance, on order entry and chief complaint) allows Mercy clinicians to access context-speciﬁc information within seconds. This, coupled with ease-of-access, has significantly enhanced clinician adoption and use.
Stakeholders responsible for delivering high quality, efficient care should be strong advocates for the inclusion of CDS in an organization’s health IT investment portfolio. Early adopters like Mercy have demonstrated the success this approach can have. Furthermore, CDS tools will continue to improve if stakeholders advocate for strong collaboration among EMR vendors, CDS vendors and health systems.
There is also an economic argument strongly supporting the implementation of CDS—one that will resonate with the C-suite and financial stakeholders. For example, more than 60 published studies have assessed UpToDate in a variety of settings. Some have shown it has a measurable impact on knowledge acquisition and performance in continuing medical education. Studies looking at health outcomes show an association with improved efficiency, patient safety, better quality care and lower mortality.
Ultimately, the benefits of CDS that is properly integrated into both clinical systems and workflows translate not only into better care, but also a measurable return on investment. It becomes a win-win-win for clinicians, patients and administrators.
About the author
Denise Basow, MD, is Vice President and General Manager of UpToDate at Wolters Kluwer Health, Clinical Solutions.