Managed Care - June 2008 - (Page 44)

Clinical Decision Support On Slow Road to Adoption These systems can improve quality, but in their present state of development, they can annoy physicians and are underutilized By Tom Reinke alone computerized provider order entry systems in hospitals or drug interaction alert systems in e-prescribing software. CDS systems are also a cornerstone of disease management programs, where case managers follow up with patients and their doctors based upon the system’s recommendations. “The primary benefit of clinical decision support to health plans is that it saves money while improving quality,” says Lonny Reisman, MD, who is the CEO of ActiveHealth Management, an independent subsidiary of Aetna that has developed its own CDS system. A published study on the use of its system in a commercial health plan reported 8.4 percent fewer hospitalizations and $8.07 per member per month saved. CDS systems help clinicians in two ways, says Krall.“First, they are a resource for diagnostic support by allowing doctors to solicit information, like looking up clinical guidelines, graphically displaying historical test results, or providing order sets for a particular condition. Second, they produce unsolicited information in the form of alerts or recommendations. Those recommendations may be admission order sets or suggestions for alternative tests.” M rs. Jones, a 64 year old with diabetes, goes to her physician’s office for an upper respiratory infection. She has not been there for a few months. The doctor greets her and notes that Mrs. Jones is overdue for blood monitoring for diabetes and cholesterol, and that she should have a mammogram. But the flags in this hypothetical visit are not sticky notes posted on the chart by a medical assistant. Rather, they are alerts presented in the electronic health record (EHR), created by a clinical decision support (CDS) module, says Michael Krall, MD, a family physician and medical informaticist at Kaiser Permanente. Even better, says Krall, is that the CDS module recommends medication changes based on data it extracts from the patient’s last blood tests and today’s blood pressure check. The CDS system benefits the patient, helps the practice earn a bonus payment, and bolsters the health plan’s efforts to gain NCQA accreditation. (Diabetes control is a HEDIS measure required for accreditation. It is also a measure in many pay-forperformance programs.) Similar to the navigation systems in cars, clinical decision support systems provide doctors and other clinicians with patient care roadmaps that are intended to improve quality, efficiency, and effectiveness. CDS systems encompass clinical guidelines that cover the management of specific diseases. They also access huge databases containing detailed information about medications. They scan patient records for details about tests, medications, and diagnoses for individual patients and they cross-tabulate all of this information to produce alerts and to feed details to doctors at the point of patient care. They also exist in simpler forms, such as stand- Close tracking CDS has other potential value. François de Brantes, CEO of the Bridges to Excellence P4P program, says the reporting capabilities of CDS modules allow close tracking and efficient reporting on P4P measures, a benefit to both health plans and the provider organization. He says that a CDS system is less likely to miss patients covered by a measure or to report on the wrong patients, in comparison to the common manual reporting methods. Reisman describes a specific example of this reporting capability. “Measuring performance on the use of ACE inhibitors [a common quality measure] 44 MANAGED CARE / JUNE 2008

Table of Contents Feed for the Digital Edition of Managed Care - June 2008

Managed Care - June 2008 Editor’s Memo Contents Viewpoint Letters News and Commentary Legislation & Regulation Medication Management Compensation Monitor Plans Chart Course in Rough Waters A Conversation With Barbara Starfield, MD Smoke Signals from Payers Slow Going for Clinical Decision Support Back Pain and Physical Therapy Formulary Files PlanWatch Outlook

Managed Care - June 2008

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