Clinical Decision Support

Imagine that you have been appointed Director of Clinical Decision Support at a healthcare delivery system. This healthcare system consists of several large hospitals and multiple outpatient clinics and uses the same EHR system across the enterprise. There has been limited CDS activity at the institution prior to your arrival. Now, with the increasing need to provide increased care value, the appropriate use of CDS is an institutional priority. The current CDS available at your institution consists primarily of off-the-shelf drug-drug interaction and drug allergy alerting, which is the source of significant clinician complaints due to the rate of false-positive alerts. There is a strong sense within the institution’s administration that IT in general and CDS specifically should be leveraged to improve care value and to enable the institution to influence its clinical practice patterns more systematically and more rapidly. You have a reasonable budget and adequate staff to make meaningful changes and you do have support from key institutional stakeholders, including healthcare system executives, the nursing informatics officer, and the chief medical informatics officer. You have been asked to devise a strategic plan for CDS at your institution within 3 months of your arrival and to have concrete “wins” within 12 to 18 months.

Discussion Questions

1. Describe the approaches you would use to ensure that all aspects of patient care were considered when developing a CDS system. How would you prioritize the efforts of your CDS team? Potential areas on which to focus include areas in which payment rates are tied to national quality measures, CDS interventions that meet Meaningful Use requirements, readmissions for congestive heart failure and other care events for which payers are increasingly not reimbursing, and areas that have been identified as institutional priorities for clinical improvement.

2. How would you balance the need to deliver desired CDS capabilities quickly against the benefits of establishing robust infrastructure to enable future deliverables to be implemented more quickly?

3. Identify one area for quality and value improvement. Define the CDS interventions that you would implement to address this area of need. Describe how your approach aligns with the best practices discussed in this chapter, such as the CDS Five Rights, the CDS 10 commandments, and the desire to use standards-based, scalable approaches. How would you systematically measure the impact of these CDS interventions?