So You Want to Do CDS A C-Level Introduction to Clinical Decision Support.

So You Want to Do CDS

A C-Level Introduction toClinical Decision Support

What is Clinical Decision Support(CDS)?

Clinical decision support is a process for enhancing health-related decisions and actions with pertinent, organized clinical knowledge and

patient information, to improve health and healthcare delivery.

Source: Improving Outcomes with CDS: An Implementer’s Guide, HIMSS 2011

The Components of CDS

• Information recipients‑ Include patients, clinicians and others involved in

patient care delivery• Information delivered

‑ Include general clinical knowledge and guidance, intelligently processed patient data, or a mixture of both

• Information delivery formats‑ Drawn from a rich palette of options that includes data

and order entry facilitators, filtered data displays, reference information, alerts, and others.

Source: Improving Outcomes with CDS: An Implementer’s Guide, HIMSS 2011

Like a GPS, CDS supplies information tailored to the current situation, and

organized for maximum value.

A simple and classic CDS example:Drug warnings

A More Elaborate CDS Example:Order Sets

Types of CDS

• Drug-Drug Interactions • Drug-Allergy interactions • Dose Range Checking • Pick lists• Standardized evidence

based order sets • Links to knowledge

references • Links to local policies • Alerts

• Rules to meet strategic objectives (core measures, antibiotic usage, blood management)

• Documentation templates • Relevant data displays • Point of care reference

information (i.e. InfoButtons) • Web based reference

information • Diagnostic decision support

tools

CDS is a Strategic Tool

• CDS is a strategic tool for achieving an organizations priority care delivery objectives. ‑ Some objectives are driven by external forces

such as payment models and regulations related to improving care quality and safety

‑ Other objectives are driven by internal needs for improving quality and patient safety, reducing medical errors, increasing efficiency and other performance enhancements.

Examples of The Value of CDS

• Quality‑ By guiding users to best practices

• Safety‑ By verifying an action was the intended one

• Cost‑ Catching duplicate or unnecessary orders

• Documentation‑ By bringing forth documentation tools based on a diagnosis or

problem• Communication

‑ Of system priorities or initiatives‑ Among providers of patient status

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CDS can improve adoption of best practices Use of recommended H2 blocker before and after CPOE

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Challenges of implementation

• Speed • Usability and workflow• Avoiding over-alerting• Cultural change• Management backing• Clinical leadership backing

Need for Leadership Commitment

• CDS interventions impact workflow throughout an organization; therefore leadership at all levels must understand and support the efforts

• CDS programs require ongoing investment of capital and personnel

• A champion is required to be a change agent and lead the charge

CDS Does Not Make Policy

• CDS should not be thought of as the only tool available to solve the organization’s problems or communicate change. There are clear limitations to CDS interventions.

• When new policies or procedures are established, they should be thoroughly discussed by all relevant stakeholders before they appear in a CDS intervention.

Implementation skill is criticalDavies winners assessment of amount of effort spent on design and implementation

Design

Implementation

And once implemented, it must be maintained; an ongoing process

Ensuring a Successful CDS Program

• The value of the CDS to the organization must be consistently and continually communicated at all levels

• Close monitoring of all CDS must occur regularly to ensure validity. All efforts should be made to prevent alert fatigue.

• Successful CDS programs implement interventions WITH the stakeholders, and not TO the stakeholders

• CDS programs are a long-term commitment, must be prepared for the long haul

• Be prepared to deal with resistors and detractors, including the ability to answer any negative articles that appear in the literature

• Done well, it will help you improve the quality, safety and efficiency of the care you provide your patients while reducing your costs

FOR MORE INFORMATION

HIMSS CDS Web Site:

http://www.himss.org/ASP/topics_clinicalDecision.asp