What is Clinical Decision Support?
One of the most promising strategies available for improving the efficiency and effectiveness of health care is clinical decision support (CDS), which entails providing clinicians, staff, patients or other individuals with knowledge and person-specific information, intelligently filtered or presented at appropriate times, to enhance health and health care.
CDS has been thrust into the spotlight as part of the Centers for Medicare and Medicaid Services (CMS) Meaningful Use (MU) requirements. CMS requires that healthcare organizations implement just 5 CDS interventions to comply with MU Stage 2, providing only a glimpse of CDS benefits.
Taken broadly, clinical decision support includes anything used to make medical decisions, including textbooks and journal articles. But CDS systems—which is what we really mean when we say “clinical decision support”—automate this knowledge and deploy it intelligently through an electronic health record (EHR) so the latest evidence-based medicine can be delivered to the right provider, for the right patient, at the right time.
The patient- and context-specific information deployed through CDS is triggered by clinical decision support rules; delivery usually takes the form of alerts and notifications. For example, a simple rule might specify that if no flu shot is recorded in a patient’s EHR and it’s flu season, the provider receives an alert to recommend a flu shot.
There are other features that extend CDS. Computerized physician order entry (CPOE) allows providers to take action directly in an alert pop-up window when a medication or procedure is recommended. Dynamic communications services can route alerts across platforms and re-route notifications when they go unacknowledged by the primary recipient.
In his book Medical Informatics: An Executive Primer, Ken Ong, MD, Chief Medical Informatics Officer at New York Hospital Queens, wrote “if a physician followed all the recommendations from national clinical care guidelines for preventive services and chronic disease management and added the time needed to answer phone calls, write prescriptions, read laboratory and radiology results and perform other tasks for a typical patient panel of 2,500, he or she would need 21.7 hours per day.”
The goal of CDS is to expedite this process of integrating best practices from the latest medical research into patient care, translating protocols sometimes literally from paper sheets in a binder shared by an entire department to computerized logic automatically deployed in every exam room. The opportunity to take the variance out of healthcare through the use of automation is huge; CDS and its role in standardizing care is key to changing healthcare in the U.S.—one behavior at a time.
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