So You Want to Do CDS
A C-Level Introduction to
Clinical Decision Support
What is Clinical Decision Support
(CDS)?
Clinical decision support is a process for
enhancing health-related decisions and actions
with pertinent, organized clinical knowledge and
patient information, to improve health and
healthcare delivery.
Source: Improving Outcomes with CDS: An Implementer’s Guide, HIMSS 2011
The Components of CDS
• Information recipients
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Include patients, clinicians and others involved in
patient care delivery
• Information delivered
-
Include general clinical knowledge and guidance,
intelligently processed patient data, or a mixture
of both
• Information delivery formats
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Drawn from a rich palette of options that includes
data and order entry facilitators, filtered data
displays, reference information, alerts, and
others.
Source: Improving Outcomes with CDS: An Implementer’s Guide, HIMSS 2011
Like a GPS, CDS supplies information
tailored to the current situation, and
organized for maximum value.
A simple and classic CDS example:
Drug warnings
A More Elaborate CDS Example:
Order Sets
Types of CDS
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Drug-Drug Interactions
Drug-Allergy interactions
Dose Range Checking
Pick lists
Standardized evidence based
order sets
Links to knowledge references
Links to local policies
Alerts
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•
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Rules to meet strategic
objectives (core measures,
antibiotic usage, blood
management)
Documentation templates
Relevant data displays
Point of care reference
information (i.e. InfoButtons)
Web based reference
information
Diagnostic decision support
tools
CDS is a Strategic Tool
• CDS is a strategic tool for achieving an
organizations priority care delivery objectives.
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Some objectives are driven by external forces
such as payment models and regulations related
to improving care quality and safety
Other objectives are driven by internal needs for
improving quality and patient safety, reducing
medical errors, increasing efficiency and other
performance enhancements.
Examples of The Value of CDS
• Quality
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By guiding users to best practices
• Safety
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By verifying an action was the intended one
• Cost
-
Catching duplicate or unnecessary orders
• Documentation
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By bringing forth documentation tools based on a diagnosis
or problem
• Communication
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Of system priorities or initiatives
Among providers of patient status
CDS can reduce errors
Reduced dosing errors after implementing CDS with CPOE
2.5
% of orders
2
1.5
1
0.5
0
Pre-OE
Post-OE
Year 1
Year 2
Year 3
Teich JM, Merchia PR, Schmiz JL, Kuperman GJ, Spurr CD, Bates DW. Effects of physician order entry on prescribing practices. Arch
Int. Med. 2000 Oct 9;160(18):2741-7
CDS can improve adoption of best practices
% of orders
Use of recommended H2 blocker before and after CPOE
100
90
80
70
60
50
40
30
20
10
0
-7
-6
-5
-4
-3
-2
-1
0
1
2
3
4
5
6
7
8
Week
Teich JM, Merchia PR, Schmiz JL, Kuperman GJ, Spurr CD, Bates DW. Effects of physician order entry on prescribing practices. Arch
Int. Med. 2000 Oct 9;160(18):2741-7
Challenges of implementation
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Speed
Usability and workflow
Avoiding over-alerting
Cultural change
Management backing
Clinical leadership backing
Need for Leadership Commitment
• CDS interventions impact workflow
throughout an organization; therefore
leadership at all levels must understand and
support the efforts
• CDS programs require ongoing investment of
capital and personnel
• A champion is required to be a change agent
and lead the charge
CDS Does Not Make Policy
• CDS should not be thought of as the only tool
available to solve the organization’s problems
or communicate change. There are clear
limitations to CDS interventions.
• When new policies or procedures are
established, they should be thoroughly
discussed by all relevant stakeholders before
they appear in a CDS intervention.
Implementation skill is critical
Davies winners assessment of amount of effort spent on
design and implementation
Design
Implementation
And once implemented, it must be maintained; an ongoing process
Ensuring a Successful CDS Program
• The value of the CDS to the organization must be consistently
and continually communicated at all levels
• Close monitoring of all CDS must occur regularly to ensure
validity. All efforts should be made to prevent alert fatigue.
• Successful CDS programs implement interventions WITH the
stakeholders, and not TO the stakeholders
• CDS programs are a long-term commitment, must be prepared
for the long haul
• Be prepared to deal with resistors and detractors, including the
ability to answer any negative articles that appear in the
literature
• Done well, it will help you improve the quality, safety and
efficiency of the care you provide your patients while reducing
your costs
FOR MORE INFORMATION
HIMSS CDS Web Site:
http://www.himss.org/ASP/topics_clinicalDecision.asp