When asked which element of electronic clinical decision support (CDS) was having the greatest positive impact on their organizations, healthcare providers cited orders sets more than any others, according to a recent KLAS report, Clinical Decision Support: Striving for More Intelligent Care.
While 38% selected order sets, evidence-based alerts and reference content were also mentioned as most impactful by 19% and 10% of providers, respectively. The report outlines current provider activity in five key CDS areas: order sets, multi-parameter alerting, nursing care plans, reference content, and drug information databases.
The report also highlights the third party (non-EMR) vendors that providers are turning to for help with CDS content and development. Providers were most likely to turn to a third party for drug information databases, reference content, and order sets, and least likely to use an outside vendor for multi-parameter alerting. Those that used third-party content for order sets reported varying levels of difficulty integrating that content into their core clinical system.
For some, going to a third-party for order sets helped them get jump started on the road to computerized provider order entry (CPOE), and offered a neutral, evidence-based starting point for physicians to work from on their way toward establishing organization-wide standards. For others, integration barriers between third-party order-set providers and their core EMR proved an obstacle too difficult to surmount.
On the side of "going it alone," and handling the creation of electronic order sets in-house, then maintaining them over time as evidence-based insights change, Jason Hess, KLAS general manager for clinical research and author of the report, said that was certainly a tall order, though not out of reach for all. Many academic medical centers, he said, had the best clinical knowledge in the world in the specialty areas they focus, and thus are reluctant to seek off-the-shelf order sets from a third party. Maintenance, however, could be the issue that sends them shopping. The question, he says, is, "What do you have in place so that, as evidence and knowledge changes over time, you can keep those order sets updated?"
When it comes to multi-parameter alerting, most worked with their core EMR vendor, rather than seeking third-party help. According to Hess, that's largely because only the EMR vendor will be privy to all the data streams -- lab values, patient vital statistics, medication lists, etc. -- which must be analyzed to produce sophisticated alerts. "It's very much the core EMR vendor that's providing the mixing bowl for that -- where you can see all of that information in a common area."
Vendors most often mentioned by providers were: Order Sets -- Zynx Health, ProVation (Wolters Kluwer); Reference Content -- UpToDate, MD Consult, DynaMed; Nursing Care Plans -- Zynx Health, CPMRC; Drug Information Databases - Multum, FirstDataBank, Micromedex, Lexi-Comp.
Looking forward, Hess said providers would soon seek to quantify the value they've derived from such advanced clinical decision support tools.
"Most view (Meaningful Use) Phases 2 and 3 as about getting data out of the systems. With everyone pushing toward CPOE, the question becomes what do you do with the data that you've got? Can you prove that some of the clinical decision support tools that you have are really having an impact? It's going to be about reporting and business intelligence and being able to derive value."