Clinical Decision Support in a Medical Home

An Overview

Donna M. D’Alessandro, M.D.donna-dalessandro@uiowa.edu

Coming Soon!

• PCPCC’s White Paper on Clinical Decision Support in the Medical Home

What is Clinical Decision Support (CDS)?

• CDS is defined as providing clinicians or patients with clinical knowledge and intelligently-filtered [appropriate or key] patient information to enhance patient care.

Healthcare Information and Management Systems Society Fact Sheet

• CDS delivers information that is highly relevant to the current situation, and then is presented for the most effective use.

Health Information Technology Needs CDS

• HIT in isolation will not lead to improvements in quality/ efficiency - it needs CDS.

Neonatal Jaundice

The 5 Right’s of CDS

• The goal of CDS is to provide:• The Right information• to the Right person• in the Right format• through the Right channel• at the Right point in clinical workflow

CDS interventions can:

• Detect potential safety and quality problems and help prevent them• Drug/drug interactions, allergies

• Foster the greater use of evidence-based medicine principles and guidelines

• Detect inappropriate utilization of services, medications, and supplies

CDS interventions can:• Organize, optimize and help operationalize the details of

a care plan• Help gather and present data needed to execute this plan

CDS Interventions Can:

• Ensure that the best clinical knowledge and recommendations are utilized to improve health management decisions by clinicians and patients

CDS Categories

• Structured Templates/Checklists (may already be used in paper form)

• Order Sets

• Alerts/Reminders

• Algorithms/Protocols

CDS Categories

• Links / infobuttons to online resources/reference information• Evidence-based clinical guidelines• Online risk-assessment calculators• Online textbooks/educational

resources – pathology lab testing book

• Patient data reports, graphs and charts to display change in metrics over time (eg, Hba1c, blood pressure) - BMI is automatically calculated too !

What are the potential problems of CDS?

• Poor integration with physician workflow – stand alone applications

• Alert fatigue – too many and intrusive

• Can’t act immediately on suggested actions

What are the potential problems of CDS?

• Can’t act immediately on suggested actions

What are the potential problems of CDS?

• Clinical frustration• “Cookbook medicine”• Change in workflows/extra

steps/unproven value

• Pressure to implement decision support based on limited evidence – not enough data available to act upon

Decision Support in the Medical Home

• Requirements - National Committee for Quality Assurance

• Requirements - “Meaningful Use”• Drug-drug, drug allergy, drug formulary checks• Send reminders to patients for preventive care• Implement 5 CDS rules relevant to specialty or

high clinical priority• More requirements and recommendations

For More Information:

• Health Information and Management Systems Society http://www.himss.org

• Agency for Healthcare Research and Quality http://healthit.ahrq.gov (Knowledge Library)

CDS is all about Healthy Patients and Families