Many who work in healthcare see clinical decision support systems (CDS) as key to helping the industry solve its problems with medical errors and escalating costs. Trouble is, it hasn’t yet become part of the machinations of change in Washington and among the medical profession’s thought leaders.

But a new report from the American Medical Informatics Association is designed to shine a spotlight on the importance of deploying CDS as a tool to improve decision-making, enhance patient services and optimize costs.

Map to better decision-making

“Clinical decision support puts knowledge in the hands of healthcare team members so they can make good decisions,” said Jerome Osheroff, MD, who spearheaded the AMIA report, titled A Roadmap for National Action on Clinical Decision Support. “It can improve outcomes, so why isn’t it being used everywhere? The roadmap offers answers about what we can do to leverage information technology and empower clinicians.”

Osheroff, chief clinical informatics officer for Greenwood Village, Colo.-based Thomson Micromedex, said the report recommends standards, suggests how to lower barriers to adoption and offers instruction for successful CDS deployment techniques.

The Roadmap report represents a “milestone” in advancing an industrywide implementation of CDS and elevating it from relative obscurity to a front-burner issue among the healthcare brain trust, Osheroff said.

“We are drawing coordinated attention to the issue and are engaged in the task of bringing all the stakeholders together,” he said. “We cannot solve healthcare’s problems alone, nor can the government or the individual. We need to get everyone together to talk about it.”

Patient-specific information

Technology has evolved to the point where current CDS systems are accomplishing the necessary objectives for improving healthcare, said Jeff Reihl, executive vice president for Thomson Micromedex. The company’s acquisition of Mercury MD in June solidified its CDS approach, he said.

“We have developed new applications for delivering patient-specific information to clinicians,” Reihl said. “From the point of care, physicians can access patient information and additional evidence-based information on drugs, diseases and lab results. It is concise, granular information in the context of each patient and is only a click away.”

CDS vendors have continually refined their approach to the systems in order to lure clinicians away from manual processes and into the electronic format.

Over the past seven years, San Mateo, Calif.-based Epocrates has gone from developing clinical software for PDAs and other mobile devices to subscription products that put a wealth of medical content at the physician’s fingertips, said Michelle Snyder, vice president of marketing.

“By entering the patient’s demographic information, the physician can access 30 drugs and their interactions in one second,” she said. “That’s impossible with a book.”

The system also saves time by eliminating the need to constantly call the pharmacy for prescription verifications and formulary specifics, Snyder said.

Having instant access to drug information has become an indispensable asset for Patricia Dawson, MD, who proclaims she is now an “evangelist” for the Epocrates product.

“As a specialist, I don’t put people on medications for blood pressure, but often see people who are on them,” said Dawson, a Seattle-based breast cancer surgeon. “I’m not always current on these medications and now I have the ability to easily look it up. Previously I had to find a printed directory and read through it. It was quite cumbersome.”

Involving the patient

Systems like Hudson, Ohio-based Lexi-Comp’s Health-PALS are also looking beyond medications into disease states, cutting edge medical procedures and even insurance coverage status, said COO Steven Kerscher.

“By expanding into conditions and procedures with Health-PALS, we are giving caregivers one access point to customize important information for patients,” he said.  “If patients have something to refer back to after their hospital stay, they are more likely to follow all of their instructions – ultimately improving chances for a better outcome.”

Quick, easy access to reputable information has indeed become the chief selling point for converting physicians to clinical decision support, added Stephen Hau, vice president of marketing and business development for Newton, Mass.-based PatientKeeper. Technological breakthroughs in both the IT and telecommunications spheres have resulted in a system that physicians are increasingly comfortable using, he said.

“Doctors are really buying into it now,” Hau said. “The segment is growing at an impressive clip.

For years companies have tried to develop products for physicians and were met with a lukewarm reception. But they have largely embraced wireless technology and now want the integration capabilities with the hospital systems. It is a cultural shift that has been phenomenal to witness.”

CDS has also moved into alternate points of care, such as home health. Candy Willhite, a clinical systems specialist for Lancaster, Pa.-based Thornberry, says field nurses are also benefiting from remote access to patient information.

“They can carry the entire patient record on their laptops, have access to the most current information and don’t have to worry about missing the last set of notes,” she said. “This gives them enormous understanding of patient status and the level of accuracy is nearly flawless.”

Osheroff acknowledges the medical profession is gradually waking up to the advantages of CDS and is confident that it will be embraced industrywide. He is also realistic that full-scale change won’t happen overnight.  

“CDS has tremendous power, but it is only currently being harnessed on a small scale,” he said. “We are at the beginning of what promises to be a very long journey,” he said.