The Case for Integrated Clinical Decision Support Software in EMRs

Several recent studies have highlighted the benefits of clinical decision support software.

Researchers from the Hofstra North Shore-LIJ School of Medicine in Manhasset, N.Y., found physician use of CDS was linked to a reduced number of antibiotics prescribed and point-of-care tests ordered, publishing their results in JAMA Internal Medicine. Researchers from Duke University in Durham, N.C., found CDS helped improve clinical preventative care processes, both within and outside of large academic hospitals (findings in Annals of Internal Medicine). And a study published in the American Journal of Health-System Pharmacy shows CDS to be effective in detecting adverse drug interactions in hospital inpatients.

Additionally, when using CDS, physicians are not "gaming the system" to have the software return desired results, allowing the system to modify actions to comply with best practices. A study published in the Journal of the American Medical Informatics Association analyzed emergency department physicians' use of CDS when ordering CT angiography exams for pulmonary embolism patients. Physicians were aware there was a cutoff D-dimer value to be able to order the CTA through the CDS, though just 4.2 percent of data entry errors made were determined to have been an attempt to trick the system.

For Lucio Martinez, MD, hospitalist and order set champion at FHN Memorial Hospital in Freeport, Ill., full CDS integration is what's missing from electronic medical record systems currently on the market. EMRs alone "do little to help physicians and hospitals improve quality performance," he says. "Because EMRs are little more than static repositories of patient information, they simply cannot provide physicians with the actionable patient information needed to guide diagnoses and treatment decisions based on accepted best practices."

EMRs could be improved, says Dr. Martinez, by integrating CDS systems within the EMR, which is not always an easy task with products currently on the market. "The reality is that EMRs were not designed to direct clinical practice or support third-party applications, which often equates to the need for building costly interfaces between CDS applications and EMRs to support point-of-care initiatives," he says.

At FHN Memorial Hospital, integration issues were resolved by deploying an order set and decision support software that interfaces with the hospital's current EMR system. The hospital worked with the vendor, Wolters Kluwer Health, to design the solution so that the support functionality addressed known weaknesses in the hospital's core performance. "For example," says Dr. Martinez, "we embedded creative 'stops' to encourage appropriate documentation against core measures or areas of variance from best practices."

These measures add extra costs for hospitals, says Dr. Martinez, percentage-wise or absolutely. Care delivery across the industry would be improved by the more complete integration of CDS into EMRs. "While progress is being made to address these challenges, CDS and EMR vendors and providers must engage in even closer collaborations to fully leverage the potential of CDS within the EMR," he says.

More Articles on Clinical Decision Support:

AHRQ Projects Show Positive Impact of HIT on Care Quality
HHS Workgroup Says FDA Regulation of Health IT Mostly Unnecessary
System Refinements to EHRs Could Lower Prescribing Errors, Study Finds

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