CDS Done Right

December 18, 2012 in Medical Technology

The decision to implement clinical decision support (CDS) may be a tricky one. Once you’ve committed to spending the time, money and resources on getting it up and running, you want to be certain it will fly within the scope of what your healthcare system can offer. CDS is all about providing a template or launching pad for physicians to base their orders off of, making healthcare safer, more efficient and more effective – it is none of those things if the CDS a hospital implements isn’t fine-tuned for what they can offer.

Optimizing CDS for a healthcare network is far more challenging than simply installing some software and pushing some buttons. Implementing a quality CDS framework requires testing, outreach and a constant focus on what options each provider has.

Hemant Gupta, MD, CMIO at Lourdes Hospital in Binghamton, N.Y., which is part of Ascension Health, was able to speak candidly about his organization’s adoption, implementation and optimization of a CDS system. Gupta says they started by adopting a nationwide order set from Zynx and then “reviewed those order sets for best practices against the evidence they provided and made an Ascension health order set.” Gupta stresses that with today’s massive amount of order set data, to succeed in implementing CDS a system needs to focus specifically on their needs.

1. Customize for commonly used local tests and frequently treated conditions. Spoiler alert: Distillation is the buzzword in making CDS a workable part of a healthcare organization. In Ascension’s case, they boiled down Zynx’s order set to a more manageable one, then pushed out a localized version to each of its hospitals. If a procedure isn’t available at a certain hospital, or if lab results take months to come back for a certain test, it doesn’t make sense to include it in the order set. Gupta says that making the CDS system work in Ascension’s many hospitals comes down to “pruning to what is really useful and flagging the most critical things to doctors and nurses who are using the system.” Gupta likens this to going to a dealership and asking for a car with all of the features – most people will work back from there to end up at something with only the features they really need. “That requires the local regional institution to exercise some judgement on what to show,” says Gupta.

2. Refine list of medications locally used to become more user-friendly. “When it’s redundant, we don’t need it.” Gupta says that one of the main problems that a CDS system can cause is by being overly-complicated. When certain medicines aren’t available or even effective in one region, striking them from the more commonly-used lists can streamline a process that quickly becomes clogged with scads of non-relevant and time wasting information. “It’s coming down to pruning to what is really useful and flagging the most critical things to doctors and nurses who are using the system,” says Gupta. In essence, this statement sums up the process of making a CDS system fly: Refine, prune, and tighten until the system delivers only the most relevant and useful results. “The longer the order set, the less people actually find it useful. It just makes it less functional and less efficient,” says Gupta.

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