Feature | Clinical Decision Support | November 11, 2015 | Steve Oden

Going beyond simple compliance offers the ability to positively impact care quality, care cost and patient satisfaction

clinical decision support

Jan. 1, 2017, marks the date that provider organizations must begin accompanying Medicare radiology claims with proof of the use of clinical decision support (CDS) in the ordering process to receive full reimbursement. This represents a milestone in the effort to improve patient care quality while reducing the cost of care.

Rather than simply promoting the acquisition of a tool or the production of a report, this mandate is a requirement for sound point-of-care decisions based on clinical patient care data and comprehensive image-utilization best practices. As a result, the rule will usher in a new era of real-time decision-making support that will reduce costs by eliminating unnecessary procedures, and will improve the patient experience by reducing subjection to unnecessary radiation exposure. It also opens the door for provider organizations to reap the benefits of CDS well beyond what’s required to comply.

How CDS Can Improve Radiology Ordering

Advanced CDS systems typically run primarily in the background of an electronic health record (EHR) system as they capture, read and interpret all of a patient’s data, and analyze it based on the healthcare organization’s best practices. The CDS system then issues an alert when a clinician’s EHR entry indicates a deviation from those best practices.

In the case of radiology, evidence-based guidelines assist the ordering provider in making the most appropriate imaging decision for a patient in accordance with the patient’s complete clinical picture. The guidelines can include, for example, the lowest effective radiation dosage for imaging when a range is generally available. They may also prevent unnecessary radiation orders when best practices consider the order to not be a clinical necessity.

When CDS is aware of the patient’s full medical history, it can also help to eliminate duplicate imaging. The clinician who orders the imaging does not have to research or simply know if the patient recently had the same procedure or that another pending order exists; the CDS will automatically prompt an alert and supply the information in
real time if duplications are made.

Comprehensive CDS systems can add substantial value to radiology departments beyond mere compliance with the CMS rule, particularly as it concerns workflow efficiency. For example, if a patient is due to have a lab test or specific procedure completed in advance of imaging and it has not been recorded, the CDS can issue an appropriate alert, eliminating potential delays. 

Clinical Value Beyond Radiology

For provider organizations that do not already have a CDS system in place, the requirement to begin using one in radiology presents an opportunity to consider additional, clinically beneficial CDS applications for the greater benefit of the organization. Moreover, the CMS radiology rule impacts radiology imaging utilization across the healthcare enterprise, from outpatient procedures to emergency department (ED) ordering. From a broader perspective, this is not only an opportunity to improve imaging utilization and radiology ordering, but also to implement a comprehensive CDS platform that can be expanded to address a full set of clinical and administrative needs across the entire healthcare system. As such, it is important to include other stakeholders within the organization when making your CDS selection.

As was the case with EHRs, it’s a question of simply achieving tactical compliance versus gaining an operational and clinical quality advantage for the organization and its patients. It is safe to say that many provider organizations were unhappy with their initial EHR selections as a result of not fully considering requirements beyond simply attesting to meaningful use. Those who more thoroughly considered the ramifications of charting electronically, and understood the advantages EHR could offer, were much better situated to make a satisfying EHR investment.

The same goes for CDS. Achieving compliance is just the beginning of what can be achieved with an effective and comprehensive, real-time point-of-care CDS platform.

The Role of CDS

CDS technology has evolved over many years and its role within provider organizations has become increasingly apparent and important. Today’s most advanced CDS solutions: 

• Accommodate the organization’s unique radiology best practices. CDS systems not only need to address CMS’ radiology requirements, but should also address the imaging utilization guidelines of the provider organization. 

• Are expandable and adaptable. Not only can CDS systems support the emerging radiology changes, but they can also meet the needs of the wider organization in terms of compliance and application. For example, radiology protocol is vastly different than ED protocol. The most advanced CDS systems are equipped to adapt to different clinical functions to accommodate these differences. 

• React to the complete clinical picture. For complete accuracy, true CDS is able to view the patient’s complete clinical care record, across disciplines, to enable accurate, rapid decision-making at the point of care. 

• Are accurate and precise. In the past, physicians have been quick to ignore important notifications due to alert fatigue caused by inaccurate CDS technology. CDS systems should be easy to reference and provide accurate assistance, 100 percent of the time. Accuracy is not an option when it comes to patient care.

When choosing a CDS system, consider involving a broad group of users in the selection process. The selection committee should be made up of key thought leaders, including at a minimum your chief medical information officer, radiology leadership and any physician groups that are generally tasked with focusing on best practices. The range of perspectives will help to ensure value wherever it’s relevant. It is also important to ensure that the system you choose is fully compatible with your existing EHR in order to maximize your EHR investment. Any requirements to upgrade or reconfigure the EHR could be disruptive in terms of time and testing.

What Happens Next?

One way or another, the new CMS radiology rule means that a CDS system of some type is on its way. Automated CDS is about to make a substantial leap from an emerging technology, with which provider organizations have varying degrees of familiarity, to a mainstream technology that is integral to a healthcare enterprise’s IT arsenal.

As such, every healthcare provider organization that has not already implemented a radiology CDS solution has an opportunity to get it right, with a sufficient amount of time before the Jan. 1, 2017, deadline arrives. Going beyond simple compliance to a more comprehensive, clinical data solution is strongly recommended. Consider the benefits of advanced CDS and its ability to positively impact care quality, cost and patient satisfaction.

Steve Oden has 25 years of software development and technical leadership experience. He spent most of his IT career with Cerner Corp., and prior to his retirement from Cerner in 2008 after 23 years, he was responsible for all of Cerner’s Millennium software development and client support. Oden used his expertise to lead the transition from a distributed business unit development model to an integrated software development and client support organization numbering in excess of 900 IT professionals working under his leadership. This newly formed organization delivered the Millennium 2007 release to over 600 live client implementations by the beginning of 2008. Prior to joining medCPU he was the chief technology officer for Ad Astra Information Systems.

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