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● Decision Support Following the By Dr. Anita Karcz I

n the past, many care providers have failed to em- brace the full benefi ts of decision-support systems. Doctors have traditionally scorned “cookbook medi- cine” and included decision support in that derided

category. T is has changed with the rapidly increasing and complex medical knowledge base of today. Information systems have also vastly improved their capacity to link relevant data and deliver it rapidly. Decision support includes many diff erent elements that may need to be considered, involving the entire scope of a patient’s care process – not just what the patient is currently being treated for, but also co-morbidities, family history, pri- mary care, social support, available resources and fi nancial considerations. Bringing together all the elements of patient information into one system eliminates fl ipping between systems and Post-It-Note-type records and documentation. Meaningful use compels organizations to integrate data into one usable information system, and in doing so, cen- tralizes the information for decision support. Only with this complete portfolio of information can decision-support systems be leveraged to provide a full complement of avail- able options for treatment at the point of care. While meaningful use is viewed by many as merely a means to secure fi nancial incentives, its benefi ts go well beyond fi nancial. Meaningful-use requirements force or- ganizations to ensure their systems are compliant, which supports a strategy to comply with the fi rst wave of the federal pay-for-performance programs, such as value-based purchasing. One of the most important benefi ts of meaningful use is that it has led organizations to confi gure their healthcare information systems (HIS) with sets of reminders/checks for those things that cannot always be instantly recalled. Just like other industries, these reminders/checks need to be in place to incorporate regulations and data as well as updates, new theories and new methods into a usable format. Meaningful use specifi cally requires use of clinical deci- sion support to comply. While there are many methods of managing the process, let’s apply the example of the iterative, four-step management method for the continu-

18 September 2013

meaningful-use path Meaningful use compels organizations to centralize information.

Dr. Anita Karcz is chief medical officer and co-founder of the Institute for Health Metrics (IHM). For more on IHM: www.

ous improvement of processes known as PDCA, or “Plan. Do. Check. Adjust.” Plan. T is step is where the organization decides how the decision-support system based on meaningful-use require- ments will look. T e organization needs to take a broad view of high-volume/high-cost diagnoses and procedures and target which ones will provide the most benefi t as initial areas for decision support. Integrating these areas with other quality initiatives should be strongly considered. Do. In this, the design phase, the organization deter- mines content and process for decision support. T ere is no need to re-invent the content wheel since there are many evidence-based resources providing algorithms for care. However, it is important to analyze these algorithms with clinicians since they are best suited to determine what data should be presented. Even with evidence-based best practices, it is vital to incorporate clinician input. A work- ing group with clinicians and clinical informatics staff can build workfl ow compatibility into system design. Check. In the measurement and testing phase, clinicians test the system for usability and accuracy. Checking allows revisions to be made (in the next step of this cycle) based upon feedback during this phase of PDCA. T is process is iterative, especially in the “C” and “A” phases. T e system should then be tested again, and ideally new clinical testers engaged for additional input. Adjust. As each test is completed, adjustments need to be made in a timely manner. Maintaining momentum is important and will ultimately accrue to adoption. With competing initiatives, IT staff can often be pulled off other projects, resulting in a lack of momentum and waning clinician interest. T e purpose of meaningful use is to guide care provid- ers to deliver best-practice care – the key word here being “guide,” because information provided does not dictate care (make decisions), but rather helps those making the decisions to be as well informed as possible. Optimizing inputs with better decision support should lead to more intelligent decision making, more appropriate patient care and more desirable outcomes.


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