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7 keys to success with clinical decision support

I realize and admit I have biases. One bias is that I believe the principle reason for the healthcare IT industry is to optimize patient-clinician interactions to heal and keep people healthy. Another bias is that without solid financials and organizational performance, everyone ultimately loses. My third bias: I believe clinicians whom we trust with our very lives, and IT experts, are trained professionals and should be trusted to optimize electronic health records (EHRs) as a local team.

EHRs should provide solid clinical decision support (CDS) to help clinicians optimize patient decisions and interactions, and help organizations exceed performance goals. CDS puts clinicians at the forefront for deciding, coding, monitoring and updating.  Here are the seven most powerful CDS-focused EHR characteristics for assisting clinicians with their decisions and documentation:

1. Programmability

Programmability ensures that hospitals can remain in sync with evolving needs and capabilities relevant to their specific populations and structures. Health care is innovation-rich and dependent, and it is always evolving and improving. While vendors may provide excellent starting points for CDS “within today’s science and delivery models,” programmability enables adaptation and innovation and progress without vendors dictating what can or should be done.

Programmability should be locally achievable so no one is held hostage by EHR vendors. The clinician-IT partnership is the key to automating and standardizing progress, with leadership and governance as key components.

2. Data Accessibility

Best improvements are achieved by seeing data-driven proof of need for change, and of support for better approaches. Ad hoc and routine data searches are crucial to both, yet most EHRs are primarily “unanalyzable data repositories” with intentionally severe limited data access. EHRs should never be designed for data acquisitions and storage, and code capture conversion capabilities alone.

Clinicians need access to data to study outcomes retrospectively, make best decisions reflecting “better,” and monitor the impacts thereafter. Clinicians and analysts can use data to identify successful approaches and then program those approaches for more routine usage. Data access will ensure that best clinical decisions are found, monitored to ensure routineness, and documented for ensured best care for all patients and practitioners.

3. Population and Patient-type Adaptability

While most healthcare communities and organizations are arguably “generalizable,” every organization remains unique in layout and staffing, and the healthcare challenges of each community and population varying between somewhat to very unique:  ethnics, genetics, socio-economics and healthcare models. Clinicians and healthcare organizations should be able to adapt EHRs and CDS to the uniqueness of each organization location and population set.

4. Specialty Adaptable

When those we care about need health care we realize the importance of specialists. Yet some EHR vendors resist or restrict adaptability to specialty-related needs, preferring instead to provide the fewest possible capabilities to meet the greatest numbers of patient types and diseases. Ideally, organizations should enable specialty-supporting CDS through their EHRs so clinicians can adapt to patient needs.

5. Innovation Ready

Best practices will change – it is a guarantee – and progress is the hallmark of health care.  As innovations become available, the EHRs and CDS should be capable of adapting to newer approaches with better outcomes. Some practitioners may resist change, and some organizations as well. Regardless, progress-related capabilities ought to enable ideal CDS, and adapt to outcomes-enhancing innovations, all without any vendors dictating what can or should not be done for better care and results.

6. Open and Integratable

Progressive healthcare organizations should not be held hostage by dictates from any EHR vendors that all applications must come from them alone as the single source. Such arrogance raises more questions than answers, at least for the logic that not one vendor “does it all.”

Open platforms mean freedom to choose. An Open EHR empowers organizations to both fill gaps in capability as innovation requires, or as specialties need. Clinicians and IT professionals are more motivated, intelligent and capable in an Open environment, while closed environments communicate that “only the EHR vendor can be trusted.”

7. Value to Clinicians

Everyone’s needs are best met when clinicians make best decisions and document them well. For this reason, I believe that EHR selection should prioritize the needs and value to clinicians, and thus meet everyone’s needs. Yet too many leaders and IT professionals choose what will help organizational performance as the first priority, and then demand clinicians show compliance and adaptability as the primarily metrics of success.

My biases frame why I remain convinced that organizations can find all of these attributes in Allscripts SunriseTM, with CDS at its very core.

What else would you add to the list of what makes CDS successful at your organization?

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About the author

Steven H. Shaha, Ph.D., DBA, is a Professor at the Center for Policy & Public Administration, and the Principal Outcomes Consultant for Allscripts. Dr. Shaha received his first doctorate in Research Methods and Applied Statistics from UCLA and has taught and lectured at universities including Harvard, University of Utah, UCLA, Princeton, Cambridge and others. An internationally recognized thought leader, lecturer, consultant and outcomes researcher, Dr. Shaha has provided advisory and consulting work to healthcare organizations including the National Institutes for Health (NIH), and to over 50 non-healthcare corporations including RAND Corp, AT&T, Coca-Cola, Disney, IBM, Johnson & Johnson, Kodak, and Time Warner. Dr. Shaha has presented over 200 professional papers, has over 100 peer-reviewed publications in print, over 35 technical notes and two books. He served on the 15-member team that authored and piloted the Malcolm Baldrige National Quality Award for Health Care, and he contributed to the Baldrige for Education.

1 COMMENT on

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Jeff Goldstein says:

07/10/2015 at 8:58 am

Excdellent comments and very applicable to the emerging trends we are seeing in healthcare.Having an EHR that can adapt to new imperatives in patient care and management but does not hold an organization “hostage” for CDS is essential for an effective system to exist.
As healthcare looks to adapt new care models such as Transition of Care coordination and Population Health, organizations must be certain that their EHRs can comprehensively support the decision-making processes needed to address these. At Allscripts, we are focused on interconnectivity that is at the heart not only of CDS, but also is designed to to help assure that quality care is provided safely and efficiently.

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