Clinical decision support
The first step in using clinical decision support is evaluating the hospital’s current support system. Dr. Weingarten says, “Hospital leaders will need to become aware of the processes used to develop, update and maintain clinical decision support in electronic health records and be sure that [it] includes all key clinical processes that have been shown to reduce mortality and readmissions and safely reduce costs and length of stay.
“I believe, based on my experience in evaluating clinical decision support in close to 20 hospitals, if the evaluation is not done in a quantitative manner it is almost certain that the organization will not include key clinical processes [or] optimize opportunities to demonstrate excellent quality of care and to improve cost outcomes.”
Dr. Weingarten says that hospitals should not assume that all clinical processes are included in a decision support system. An assessment of a system’s current capabilities is necessary to develop a strategy for using clinical decision support to increase the use of evidence-based medicine. Increasing evidence-based medicine practice will help hospital leaders form a successful ACO.
Even with a complete clinical decision support system, however, use of evidence-based medicine may not improve. To change behavior in delivery of care, hospital leaders need to work with physicians and staff to translate general standards to a specific context.
“In medicine, one of the hardest things to do is to influence clinical decision making — to [provide] physicians, nurses, pharmacists and other healthcare providers with context-specific clinical information that will lead to care consistent with evidence and best practice information,” says Dr. Weingarten.
One way to overcome this challenge is to integrate context-specific clinical information in healthcare information technology systems, according to Dr. Weingarten. For instance, the Maine Primary Care Association and Arcadia Solutions have begun an initiative to improve quality and safety through HIT. Using EHRs to encourage evidence-based medicine practices can help hospital leaders develop a successful ACO.
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