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CDS,clinical decision support,clinical documentation,electronic medical records,Electronic Medical Records and Genomics,EMRs,interoperability,medCPU

How clinical decision support fills gaps in clinical data for higher quality care


Liora Guy-David, Ph.D., Vice President of Data, medCPU

As long as the healthcare industry lacks true interoperability among dissimilar systems, clinicians will have incomplete patient information at the point of care. This includes gaps over time, as when a clinician is unaware of imaging tests already completed, and gaps across care team members who record documentation in separate systems. Both types of gaps can compromise patient safety.

While we don’t typically think of gap-closing as being a primary clinical decision support (CDS) function, CDS systems do exactly that. Its success in informing decisions depends largely on the ability to analyze information from multiple systems, closing gaps in real-time. As a result, CDS is emerging as an essential tool for improving quality of care.

Decision-making support built with a more complete view of the patient

CDS systems run on top of EMRs, analyzing documentation as it is being entered and issuing alerts in EMR windows when conditions indicate the possibility of a medical error or compromised patient safety. This is often a matter of giving clinicians information of which they were unaware.

To fully inform alerts, advanced CDS systems supplement the structured data in EMRs and pull information retrieved from other systems such as those in labs and imaging departments. CDS leverages its comprehensive patient view by applying rules-based analysis regarding diagnoses and courses of care. By augmenting a physicians’ expertise with real-time information retrieval and gap-closing, CDS systems play a key role in promoting patient safety.

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clinical decision support,electronic medical records,EMRs,medCPU

Why clinicians ignore clinical decision support systems: How to fix it?

Ami Mayo headshot

Ami Mayo M.D., Chairman of medCPU’s medical department

A major shortcoming of traditional clinical decision support (CDS) systems is that they operate on highly incomplete patient data, which sets the foundation of the usefulness of the tool. With incomplete data – prompts down the line are guaranteed to be inaccurate. Besides having access to all data, precision of this information is imperative for a CDS system to enhance care delivery and patient outcomes.

Traditional CDS systems can read and utilize only structured data entries in electronic medical records (EMRs) and ancillary systems. However, this portion of the patient’s clinical profile, represents somewhere between 30 and 40 percent of all medical information. If the system doesn’t have complete and accurate data, it’s going to error. Data and data comprehension is key.

Capturing all data and precise comprehension of this information requires the CDS system to function as closely as possible to how a physician thinks. Clinicians communicate patient data primarily through narrative reports, follow-up notes, and summaries of CT scans, X-rays and other imaging reports. In general, dictation, turned later in to free text notes, is how a significant data portion is entered into EMRs.

Approximately, 50 to 70 percent of data in healthcare, if not more, resides in non-retrievable, unusable information embedded in free text communication. This is an enormous amount of vital data that traditional systems simply can’t process because they don’t have the “intelligence”.  Seeing only a small portion of the total clinical picture makes traditional CDS systems prone to error.

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accountable care organizations,ACOs,clinical decision support,duration tables,predictive modeling,Reed Group,Triple Aim

Maximizing financial performance with intelligent clinical decision support


Joe Guerriero, Senior Vice President of MDGuidelines, Reed Group

(Editor’s Note: This article is part two of a three part series. Part one is published here. Part three is published here.)

Wasteful spending attributed to overtreatment amounts to a staggering $158-to-$226 billion annually.[1] With numbers like these, it’s not surprising that minimizing clinical care variation and controlling avoidable utilization are among the top five concerns for hospital and health system executives.[2] 

When a patient’s health is not well managed or it takes longer to heal from an illness or injury, not only does the patient suffer, but the costs shared by the patient, providers, employers and payers increase as well. In a value-based care environment, the more responsibility providers assume for the quality and cost of care, the more critical it becomes to be able to manage financial risk while improving health outcomes.

Following practice guidelines supported by medical evidence is widely proven as an effective way to achieve these goals – and could reduce U.S. healthcare costs by $90-to-$110 billion annually.[3] By leveraging intelligent clinical decision support tools at the point of care, providers can consistently employ the most effective treatments to return patients to health safely and efficiently. Once implemented, healthcare organizations can gain substantial benefits from more effective resource utilization coupled with better clinical outcomes.

Yet, many providers lack reliable, evidence-based tools at the point of care to support consistent and effective treatment. When providers don’t have access to the information and tools they need during the patient encounter, waste such as redundant or unnecessary tests and treatments, extra visits or overprescribing of medications, is often the result. By some estimates, 30 percent of all Medicare clinical care spending is actually unnecessary or even harmful and could be avoided altogether.[4]

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accountable care organizations,ACOs,analytics,clinical decision support,predictive modeling,Reed Group

Advancing value-based goals with intelligent clinical decision support


Joe Guerriero, Senior Vice President of MDGuidelines, Reed Group

(Editor’s Note: This article is part one of a three part series. Part two is published here. Part three is published here.)

How do you deliver on the promise of improved outcomes while still tightly managing costs? That’s a question that more than 700 ACOs face every day.[1] It’s also the same dilemma payers and employers have wrestled with for years, which is why it’s critical to learn from their approach. By leveraging both evidence-based guidelines and physiological duration tables, many employers have successfully returned individuals to health quickly and safely, all without wasting resources.

One key challenge, however, is that many physicians don’t have tools at the point of care to help them determine the safest, quickest path or the length of time it may take for a patient to heal and return to their normal lifestyle. As a result, there are tremendous variations in how providers manage specific conditions, injuries and illnesses. And these variations can have a negative impact on both patient outcomes and the bottom line. 

To address this challenge, ACOs can provide intelligent clinical decision support tools to providers at the point of care. With a combination of evidence-based clinical guidelines and physiological duration tables, physicians can better coordinate care around the final goal of returning patients to health, all while taking into account patients’ unique attributes and circumstances. Treatment planning can include personalization through predictive modeling based on factors like age, gender, geographic location, and underlying co-morbid conditions, such as diabetes or heart disease.

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CDS,clinical decision support,electronic alarms,electronic surveillance,Huntsville Hospital,Ohio Health Riverside Methodist Hospital,POC Advisor,sepsis,Sepsis Alliance,Wolters Kluwer

A new tool for an old fight: Using electronic surveillance and alerts to detect sepsis

Historically, sepsis has been one of the most important medical conditions in the United States, yet it is not properly appreciated by many in terms of its real significance. Unlike heart disease and cancer, where most people at least generally know about the tremendous number of deaths and the financial impacts they create, sepsis is somewhat of a mystery to the general public.

According to the National Institute of General Medical Studies, sepsis strikes more than a million Americans every year and between 28 and 50 percent of these people die – far more than the number of U.S. deaths from prostate cancer, breast cancer and AIDS combined. While a great deal of improvement has been made in treating high-profile conditions in the last 10-15 years, sepsis is lagging behind in where it could and should be in terms of care. It costs billions of dollars to the healthcare industry, but by-and-large, care for sepsis in the United States is sub-par. 

To learn more about sepsis and its seemingly ambiguous presence within day-to-day healthcare environments, I spoke with Jim O’Brien, MD, MSc, Vice President of Quality and Patient Safety, Ohio Health Riverside Methodist Hospital, an 860-bed community teaching hospital in Columbus, Ohio.

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CDS,clinical decision support,Integrated Clinical Decision Support: Accelerating Adoption of Evidence-Based Care for Optimal Outcomes,Wolters Kluwer

Wolters Kluwer e-book underscores value proposition of integrated clinical decision support to driving adoption of evidence-based care

The Health division of Wolters Kluwer, a leading global provider of information and point of care solutions for the healthcare industry, announced the release of a complimentary e-book that demonstrates the critical role of integrated clinical decision support (CDS) to driving value and optimizing patient care in today’s healthcare environments. Integrated Clinical Decision Support: Accelerating Adoption of Evidence-Based Care for Optimal Outcomes outlines the evolution of CDS technology and effective implementation of integrated solutions as a foundational strategy for improving overall clinical and financial performance.

As the timeline for value-based care accelerates on the national stage, the e-book provides timely information to equip healthcare providers with effective and sustainable CDS strategies that will increase uptake of evidence-based clinical practices. Specifically, today’s healthcare organizations must respond strategically to national initiatives such as the Hospital Value-Based Purchasing (VBP) program—placing approximately $1.4 billion in payments at risk—and plans to tie 90% of Medicare payments to quality or value measures by 2018.

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