Managed Care - June 2008 - (Page 46)

“The problem [with CDS] is knowing what to say, to whom, at what time, and then presenting the information to facilitate decision making,” says Krall. To be truly effective, CDS systems have to fit the clinical work flow and accurately reflect the patient’s status. The overuse of alerts can produce alert fatigue. “It isn’t really alert fatigue per se — it’s bad-alert fatigue and, second, it’s information overload,” says Krall. Instead of streamlining care and facilitating decision making, poorly designed systems become an intrusion. When an alert appears, the clinician must sometimes take the extra step of providing a reason for overriding it. “The human factor hasn’t been addressed very well in most systems,” says David Bates, MD, medical director of clinical and quality analysis at Partners HealthCare System. “It’s important to be conservative with alerts and to make sure they make a Partners is an integrated health system of academic medical centers and community hospitals and doctors, and it is strong on using information technology to improve care, having developed its own electronic health records system. Recently it made the leap from voluntary to mandatory use of its CDS system by all 7,000 clinicians, says Bates. Also Partners is requiring electronic prescribing, which will expand the use of the drug interaction feature. The mandate will be backed up by monitoring clinicians’ compliance. Although large organizations may be able to establish a culture that paves the way for decision support and then convert to it by executive decision, smaller organizations face more basic problems. Small providers generally acquire CDS systems from vendors and implement them in their standard configuration. But pragmatically, these systems require customization to eliminate intrusive To be truly effective, CDS systems have to fit the clinical work flow and accurately reflect the patient’s status. difference.” Partners understands these concerns, having developed its own CDS system. Partners and Kaiser have worked extensively to ensure that their systems minimize intrusion, that the alerts are not superfluous, and that they make a difference. Both organizations believe that they have overcome most of the design issues that are barriers to the use of these systems. Don Detmer, MD, the chief executive officer of the American Medical Informatics Association, points out a potentially larger issue. “The problem is not with the technology; the biggest pinch point today is actually change management. The effective use of CDS systems depends on creating a culture where decision-support is accepted by physicians and then fully integrating it into the style of practice. Usually that’s a very big change.” Detmer says some physicians resist decision support because they think they know all they need to know and are capable of making good patient care decisions. “Physicians are pretty good at making decisions but they may overlook a detail buried in the patient’s history or a clinical alternative in diagnosing — and that is exactly where decision support comes in — by integrating all available information and presenting it for consideration.” alerts or unnecessary features. Likewise, they require constant updating and other forms of maintenance that small organizations may not have the personnel to handle. Future of CDS CDS could play a larger role in improving quality. Bates says that problems such as making these systems easier to use and ensuring the accuracy of alerts and recommendations are being overcome. “The challenge is getting it out there,” says Detmer. “There must be a greater commitment to creating the IT infrastructure and in supporting the cost of widespread deployment of electronic health records.” Detmer says the federal government and payers must begin to pay physicians to use CDS systems. The use of limited versions of CDS is expanding through efforts such as the Leapfrog Group’s push for the implementation of computerized physician order entry and a variety of efforts to expand electronic prescribing, which usually includes drug interaction alerts. MC Tom Reinke is a freelance writer who specializes in health and business topics. 46 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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