In looking at the impact clinical decision support systems have had on the healthcare provider community, it is tempting to refer to the old adage “Be careful what you wish for.” Because in the healthcare context, it means “You wanted more data, now you’ve got it. What are you going to do with it?”
Anthony Jones, MD, chief marketing officer of patient care and clinical informatics for Amsterdam-based Philips Healthcare, summarizes it this way: “There is an abundance of data that is being generated and it is part of a normal progression – from too little data to too much. Healthcare now needs tools to manage the data.”
The primary tool that providers need, Jones says, is visualization and today's next generation dashboards provide that view.
“CDS systems have become more sophisticated because they are providing more real time data – but they can’t overwhelm the user,” he says. “We are reaching the state in healthcare where there is a good progression to getting to where we should be. Now it becomes about understanding what is happening between data points and that has been fascinating to watch as it unfolds.”
Philips introduced its new dashboard at HIMSS13 in New Orleans. The dashboard is built on top of its IntelliSpace eCareManager 3.9 software.
“The visualization aspect from an algorithm standpoint is advanced, but the technology is relatively simple,” Jones said. “While the appetite for more data to fill in the gaps is strong, you don’t want to overwhelm the capacity of the human brain to pick up what is most meaningful.”
The conventional method for alerts has been through audio alarms, but users routinely ignore them. Orb uses visual signs in a series of circles, dots and colors to signal clinicians in a more specific way so they know the nature of each message.
“As you bring more data together, the algorithm is smarter and that is what we’re trying to get to,” Jones said. “It is designed to leverage the critical care physician – a precious resource in the hospital.”
Leveraging CDS
Registered nurses Ann O’Brien (pictured at right) and Julie Vilardi have been immersed in CDS implementation at Kaiser Permanente for quite some time and are very familiar with the inner workings of the process. They led a session at HIMSS13 called “Leveraging Technology to Drive Change” that detailed some of the lessons they learned while deploying CDS, data mining and advanced analytics to improve clinical care.
Through development of electronic health records, each region in the Kaiser network approached a strategy for building clinical decision support into EHR deployments, says Vilardi, Kaiser’s executive director of strategic projects and clinical informatics. To date most of the focus has been on the physician population, but recently attention has turned to more strategic use by nurses, she said.
“By providing the latest information at the point of care, it can speed the delivery of care while reducing the numbers of tests and X-rays ordered."
Ann O'Brien, RN
“We have watched the effort closely and learned that if it isn’t done intelligently, it can create a lot of problems because people get too overwhelmed,” Vilardi said. “That was the starting point we used to introduce CDS in nursing.”
O’Brien, Kaiser’s director of clinical informatics, says building in ample decision support has been the key to progress so far. Through the system, physicians are plugged in to the pharmacy and labs, which provide the latest information about patient medications and test results.
“By providing the latest information at the point of care, it can speed the delivery of care while reducing the numbers of tests and X-rays ordered,” she said. “Giving physicians that information is part of the overall cost benefit. It had to start at the physician and ordering level.”
The visualization aspect Jones mentioned is definitely an essential part of the Kaiser system, O’Brien says.
“We developed a dashboard that has all patients in a unit and for multiple events any data entered is in real time,” she said. “Where we’re going is working around a multi-modal effect of dashboard and clinical reminders in the records to make sure certain tasks are being done to support clinicians at the point of care.”
Achieving transformation
Michelle Troseth, RN, has written extensively about CDS for Elsevier’s Clinical Practice Model Resource Center in Grand Rapids, Mich. and says as implementation has progressed the healthcare industry is learning more about how CDS can improve all the processes related to patient care. Still, she says providers need to generate even more momentum in order to continue moving forward.
“We need to shift our thinking from implementation to true transformation,” said Troseth, who serves as executive vice president and chief professional practice officer for CPMRC. “We’ve been so focused on implementation that we have to get beyond that and into what we’re really trying to achieve.”
CDS is an effective technology tool, but true transformation will only come when providers “start to think differently and practice differently,” Troseth said.
Absorbing the proliferation of data is the first very large step the industry will take with CDS on the ladder of learning, O’Brien said.
“There is a migration of data to information to knowledge to wisdom,” she said. “EHRs are just starting to make that leap between data to information and we’re pushing the envelope from information to knowledge. It will be up to the next generation to make it even more sophisticated with clinical intelligence.”
