BOSTON—Clinical decision support (CDS) is really about getting knowledge to the right person at the right place,” said Jonathan Teich, MD, PhD, CMIO, Elsevier at the AMDIS Fall Symposium.
With seven million pages coming out per year of new books, journals, guidelines and electronic materials, CDS must meet the challenge of intelligently filtering information at the appropriate times to enhance patient care. “When working in the trenches you have to find the paragraph you need and it has to be in the right form. Like a GPS, CDS supplies information tailored to the current situation, and organized for maximum value.”
For example, when diagnosing someone with angina, “there’s all kinds of different workflows and scenarios that require a different presentation of similar knowledge.” At Elsevier, he said its McConsult program handles hundreds of thousands of queries that, like Google, use a semantic link between what someone types in and what they really want to know.
“This smart content is turning content into action,” he said.
Healthcare organizations must be competent at continual self-improvement, and moving knowledge into the clinical context is a key part of that, added Tonya Hongsermeier, MD, MBA, CMIO of Lahey Health, based in Burlington, Mass. “Care context and learning context need to be continually checked.”
Curating knowledge also is essential to avoiding liability issues. In other words, a CDS system that isn’t updated can offer incorrect recommendations and negatively impact patient care.
To that end, Hongsermeier said whether you buy knowledge in CDS services or maintain it, you have to have a stewardship model. “If you don’t measure your knowledge management strategy and where content is meeting your business goals, you’ll fail.”
- Governance and stewardship that align CDS systems with business drivers
- A focus on reconciling paradox of standardization and personalization of care
- Externalization of CDS content from EHR to support curating knowledge
- Implementation of a collaborative platform
In the ICU environment, Joseph Frassica, CMIO and chief technology officer and vice president at Philips Healthcare, stressed “it costs a lot of money to make errors.” He said in ICUs, 150 serious errors occur per 1,000 patient days, in part due to the “immense data volume” in that environment.
To help take data and turn it into knowledge to make the right decisions, a CMS innovation grant was awarded to Mayo Clinic to develop a patient-centered cloud-based CDS solution at four sites. The automated data collection of clinical quality measure data is sent to a cloud, where real-time calculations are done, and sent back to facilitate decision making. This system, which adheres to the Acute Warning and Response Evaluation (AWARE) philosophy, identifies and presents only relevant information , Frassica said.
The CMS innovation grant study looked at the efficiency of ICU data management, including adherence and appropriateness of processes of care, provider satisfaction, rate of ICU acquired complications, resource utilization and costs.
The study proved a success. While the solution cost $16 million, “We think we’ll get $80 million in savings over the course of three years,” he said.