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Clinical Decision Support

Collaboration strategies for CDS success

Evidence-based CDS has the potential to lower costs and improve outcomes by standardizing care. By Pat Button


ince the advent of the current era of healthcare reform, U.S. hospitals have been under mount- ing pressure to improve the quality of care while reducing costs. Included in the reform legisla- tion with which hospitals must comply are the Health Information Technology for Economic and Clinical Health (HITECH) Act’s Meaningful Use of Electronic Health Records (EHR) regulations, the Affordable Care Act’s Value-Based Purchasing (VBP) program and hospital readmissions reduction programs. In addition, there are numerous other recommended reform programs in which hospitals may participate that are designed to improve quality and decrease cost.

The message is clear: In order to comply with the myriad of reform requirements, hospitals must find a way to avoid the variations in care that drive up costs and result in negative outcomes.

A study by Hillestad et al* estimates that $41.8 billion could be saved annually through the widespread adoption of an EHR system, and that 76% ($31.9 billion) of the potential cost savings is related to items that could be directly influenced by clinical decision support (CDS). Evidence-based CDS has the potential to lower costs and improve outcomes by driving evidence-based care at the bedside and improving interdisciplinary coordina- tion, resulting in the standardization of care across an organization. Care standardization also offers many op- portunities to improve care efficiency by promoting truly coordinated, non-redundant care by the clinical team. In the current healthcare environment, this kind of interdisciplinary care standardization will be a critical factor in determining whether a hospital not only survives healthcare reform, but thrives for years to come. Three factors are key in determining the success of all CDS tools at the bedside: content, technology and adoption. The impact of all three factors is significantly enhanced by the collaboration of an interdisciplinary

12 July 2012

team consisting of nurs- ing staff, physicians and other bedside clinicians, as well as quality im- provement specialists

Pat Button, Ed.D., R.N., is chief nursing offi cer, Zynx Health. For more on Zynx Health:

and the informatics team of the organization. When the right people are involved in the design and implementa- tion phases of CDS, plans of care will be provided to the bedside clinicians with critical content embedded in the clinical workflow. The lack of initial engagement by all the key stakeholders may result in poor design and a system that is not usable or meaningful to bedside clinicians.

Through the use of evidence-based CDS, clinicians and healthcare systems will gain a critical opportunity to improve quality and cost outcomes. At the same time, no CDS tool will be successful if developed outside of a collaborative team.

While effective clinical decision support requires the collaboration of clinicians, informaticists and IT, the hospital or health system chief nursing officer (CNO) must take on the role of clinical sponsor by setting the expectation that care will be delivered based on the most current research and the various regulations re- quired by healthcare reform. The clinical sponsor is also vital in providing the tangible resources for clinicians, informaticists and IT to collaborate in vetting the care plan content, getting it into the electronic health record system, doing the usability testing and actually using the plan of care in practice. After the interdisciplinary team is formed, it must follow four critical steps for CDS success:


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