Clinical decision support needs more than just alerts to improve quality

In its final rule for "meaningful use" of EMRs, CMS defined clinical decision support as technology that gives healthcare professionals "general and person-specific information, intelligently filtered and organized, at appropriate times, to enhance health and healthcare." In other words, CDS is so much more than just alerts.

As CMIO reports in this month's cover story, recent research from Duke University Medical Center and Old Dominion University's College of Health Sciences found four elements of CDS that tend to have a positive impact on clinical practice:

• Automatic provision of decision support as part of clinician workflow;
• Provision of recommendations, rather than assessments only;
• Provision of decision support at the time and location of decision-making;
• Computer-based decision support.

Summit Medical Group, a for-profit multispecialty practice in Berkeley Heights, N.J., designed its CDS to support reporting for the CMS Physician Quality Reporting Initiative, providing each physician with a dashboard view of quality measures he or she wants to monitor for each patient. Users can view patient trends over time and see how they compare to evidence-based metrics. "A lot of our quality data and outcomes data are retrospective: This gives real-time [data]," CMO Dr. Robert Brenner tells CMIO magazine. "Not only can our physicians see what they're doing with that patient, they can see how they're doing overall with all their patients compared with our group and the national standard.

"For disease management, this puts us ahead of the curve," Brenner adds. "It's giving us a lot of leverage with our physicians to make some behavioral changes and how they're treating quality measures and outcomes." And there are other benefits. In 2009, Summit earned $239,000 in bonuses from CMS for meeting quality standards.

To learn more:
- take a look at this CMIO story

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