By Patty Enrado, Special Projects Editor

To address the gap between clinical decision support's potential and current use, the Office of the National Coordinator initiated the Advancing Clinical Decision Support (ACDS) project to help drive the successful implementation and effective use of computer-based CDS interventions. Another project goal is to aid evidence-based clinical practice and the meaningful use of health IT.

In their Education Session 3, Advancing Clinical Decision Support to Support Meaningful Use of Electronic Health Records, this morning from 10:15-11:15am CST, Colene Byrne, MD, senior research analyst at Westat, Douglas Bell, MD, research scientist at RAND Health, and Blackford Middleton, MD, director of clinical informatics research and development at Partners Healthcare System, discuss new resources, best practices and tools to advance CDS design and implementation.

ONC charged Byrne, Bell and Middleton with creating resources and tools that can be put in the hands of the average end users and help them get the most out of their healthcare IT and implement CDS. "The objective that ONC had was to really address the gap that a lot of clinicians feel or experience when they're wrestling with their HIT implementation," Middleton explained. "They get a piece of software that may have some very sophisticated CDS capabilities, but it often is an empty shell in many ways; it only has a starter set of content."

"The average doctor oftentimes knows what the right thing to clinically do is, but he or she doesn't know how to translate that into a decision support mechanism or reminder that would work in their EMR," Middleton said. The point of the computer is to remind physicians what needs to be done when appropriate, but to get that logic into the computer is something that is beyond the average physician. "We think that a lot of this work points to knowledge sharing, getting the decision support in a way that the average user can make sense of it and install it in his or her computer program," he said.

The team created detailed guidelines for how to use CDS in a number of common areas such as diabetes management and smoking cessation. They cover the basic steps to convert clinical content into the required format for decision support in the EMR and how to best implement it in the EMR by way of alerts, reminders or order sets.

In their research, Byrne said they heard "loud and clear" from small practices about their immediate concerns to first be ready and ensure that they are ready. One of the how-to guides spends time helping small practices determine their readiness and their understanding of what's involved in implementing CDS.

The team also put together a summary report, a comprehensive overview of lessons learned and best practices in implementing CDS by early adopters in both the inpatient and outpatient setting. The report references another ACDS product, the Compendium of Exemplary Practices, which highlights the elements of successful implementations, according to Bell.

Byrne said that physicians need to start out with realistic goals in order to achieve early wins. "We spend a fair amount of time talking about getting started, planning, helping to build support within the organization and picking a reasonable good place or goal for CDS or type of CDS to start with."

Ultimately, Middleton said, "We want to give them [clinicians] a set or resources that will help them very practically achieve increased value from their records and better decision support and better outcomes for their patient care."