Managed Care - June 2008 - (Page 45)

requires confirmation that medication was prescribed. It also requires an accurate denominator, which means that patients with contraindications should be excluded. CDS modules can track recommended medications and provide accurate data on the number of patients where ACE inhibitors are indicated, while excluding patients where they are contraindicated.” CDS can also benefit patients, says Sandeep challenge with patients is communicating the information in the proper terms and in a way that elicits action. Reisman says the way to link doctors and patients is through personal health records that transmit prompts to patients. He adds that the flow of information could be both ways. “If a patient completes a personal health assessment in the PHR, that information could be fed to the decision support system and if there is something new or important,” an alert can be sent to both the patient and the doctor. Although this capability exists, PHR’s have not gained wide acceptance among patients. In spite of this huge potential, CDS systems are underutilized, in part because electronic health records have not caught on. In 2006, just 12 percent of physicians were using comprehensive EHRs, the kind needed for CDS systems, according to statistics compiled by the National Center for Health Statistics. CDS is also embedded in standalone electronic prescribing systems where it flags drug interactions, but in 2007 only 35 million (2 percent of 1.47 billion new or renewal) prescriptions were written electronically. PHOTOGRAPH BY CAROL SEITZ CDS in action Large providers are most likely to implement full-blown CDS systems. Kaiser Permanente has implemented its system, HealthConnect, in all of its ambulatory facilities and physician offices across the country. Kaiser’s research arm has documented statistically significant benefits from its use — for example, it found a significant decrease in the number of patients receiving contraindicated medications. But it also found that a majority of alerts from its system were not explicitly followed. “The primary benefit of clinical decision support to health plans is that it saves money while improving quality,” says That led to a study to identify the factors afLonnie Reisman, MD, CEO of ActiveHealth, an Aetna subsidiary. fecting acceptance of alerts. Kaiser’s clinicians reported that they were more likely to accept alerts on elderly patients, patients taking more than Wadhwa, MD, clinical assistant professor at the five medications, and patients with more than five University of Colorado Health Sciences Center and chronic clinical conditions. [For more about director of Colorado’s Medicaid program. “CDS HealthConnect, see “Kaiser’s EMR Push Pays Off ” can be a tool for patient education and patient selfon page 51.] Conversely, they were less likely to acmanagement of medical problems. Patient care will cept alerts when they were behind schedule with benefit greatly from putting the patient and doctor their visits. together to coordinate care,” says Wadhwa. One JUNE 2008 / MANAGED CARE 45

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

For optimal viewing of this digital publication, please enable JavaScript and then refresh the page. If you would like to try to load the digital publication without using Flash Player detection, please click here.