So You Want to Do CDS

1. So You Want to Do CDS

2. 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.

3. The Components of CDS Information recipients 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 Drawn from a rich palette of options that includes data and order entry facilitators, filtered data displays, reference information, alerts, and others.

5. A simple and classic CDS example:Drug warnings

6. A More Elaborate CDS Example:Order Sets

7. Types of CDS 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 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

8. CDS is a Strategic Tool CDS is a strategic tool for achieving an organizations priority care delivery objectives. 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.

9. Examples of The Value of CDS Quality By guiding users to best practices Safety By verifying an action was the intended one Cost Catching duplicate or unnecessary orders Documentation By bringing forth documentation tools based on a diagnosis or problem Communication Of system priorities or initiatives Among providers of patient status

10. CDS can reduce errorsReduced dosing errors after implementing CDS with CPOE There are many charts like this one – this one shows how computer systems with *very simple* clinical decision support dramatically reduce overdoses.There are many charts like this one – this one shows how computer systems with *very simple* clinical decision support dramatically reduce overdoses.

11. CDS can improve adoption of best practices Use of recommended H2 blocker before and after CPOE

12. Challenges of implementation Speed Usability and workflow Avoiding over-alerting Cultural change Management backing Clinical leadership backing Speed: It can slow a provider down if not done well. Mouse clicks and non-actionable alerts need to be minimized Usability and Workflow: CDS Interventions can be disruptive and distracting. Well designed CDS fits well into the workflow and does not disrupt unless absolutely necessary Avoiding over-alerting: Alert fatigue can cause users to overlook important ones. It is important to monitor your alert override rates and tune them over time Cultural Change: Culture eats everything for breakfast! It will be important to build a case for the potential disruption caused by a change in workflow or responsibilities Management backing: Needed to provide support for the staff who experience the potential disruption caused by some necessary CDS Clinical Leadership backing: Create the vision that this is about quality so it is embraced by staff and not seen as “cookie cutter medicine” or “just another way they are trying to control us.” Speed: It can slow a provider down if not done well. Mouse clicks and non-actionable alerts need to be minimized Usability and Workflow: CDS Interventions can be disruptive and distracting. Well designed CDS fits well into the workflow and does not disrupt unless absolutely necessary Avoiding over-alerting: Alert fatigue can cause users to overlook important ones. It is important to monitor your alert override rates and tune them over time Cultural Change: Culture eats everything for breakfast! It will be important to build a case for the potential disruption caused by a change in workflow or responsibilities Management backing: Needed to provide support for the staff who experience the potential disruption caused by some necessary CDS Clinical Leadership backing: Create the vision that this is about quality so it is embraced by staff and not seen as “cookie cutter medicine” or “just another way they are trying to control us.”

13. 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

14. 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.

15. Implementation skill is criticalDavies winners assessment of amount of effort spent on design and implementation

16. 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

17. For More Information HIMSS CDS Web Site: http://www.himss.org/ASP/topics_clinicalDecision.asp