5 Key Elements For Clinical Decision Support Systems

Allscripts has chosen DiagnosisOne's clinical decision support system to provide enhanced, real-time patient care alerts to users of its electronic health record. The integration of DiagnosisOne's smartPath platform with this leading EHR reflects the growing interest of healthcare providers in population health management as payers start requiring providers to assume financial risk.

Like other top EHR vendors, Allscripts already provides preventive and chronic care alerts to physicians at the point of care. But Mansoor Khan, CEO of DiagnosisOne, told InformationWeek Healthcare that most EHRs' built-in care maintenance prompts are "not very deep." While the systems usually allow providers to build their own alerts, he noted, "providers don't like doing that. It's tedious and carries risk if you don't do it right, and medical knowledge is quickly changing.

"So EHR vendors have decided that this is not part of their core business or their strong suit. Aside from Epic and GE with their Qualibria product, almost all the other vendors are looking to third party providers."

Indeed, the Qualibria clinical knowledge platform that GE co-developed with Intermountain Healthcare is a direct competitor to smartPath. DiagnosisOne has also sold its service to smaller EHR vendors such as Greenway, Polaris and gloStream, Khan said.

[ For more background on e-prescribing tools, see 6 E-Prescribing Vendors To Watch. ]

Allscripts President Lee Shapiro told InformationWeek Healthcare that his company partnered with DiagnosisOne because of its "real-time integration to provide alerts and care plans to the providers. As changes are documented in the patient's chart, we're able to deliver recommendations to the provider at the point of care. That's different from the alerts we provide today, which may be more static."

DiagnosisOne's Web service combines patient registries with a medical knowledge database and an analytics capability that can match a patient profile to the clinical protocols for treating a particular condition. The patient data that DiagnosisOne evaluates and that populates its data warehouse, however, does not come directly from an EHR's database. Instead, DiagnosisOne accepts EHR-generated Continuity of Care Documents (CCDs)--standardized clinical summaries--that include all the required data elements.

These CCDs may be automatically updated before, during, or after patient visits, Khan said. According to Shapiro, Allscripts' CCDs are updated whenever a physician makes a significant change in a patient's record, such as a new diagnosis. When the smartWatch application recognizes the change, it sends back new recommendations to the user, he said.

DiagnosisOne also is providing Allscripts with new capabilities in the areas of quality measures and reporting. While Allscripts' EHR already tells physicians which patients are eligible for particular measures in Medicare's Physician Quality Reporting System (PQRS), for example, it will now rely on DiagnosisOne's registry to do this and to report the data electronically to the Centers for Medicare and Medicaid Services (CMS).

In addition, DiagnosisOne will give Allscripts customers the ability to gather data on HEDIS measures that private and/or public payers may include in pay-for-performance or patient-centered medical home programs.

To perform population health management properly, a healthcare organization must be able to see which patients need preventive or chronic care services between visits or when they haven't visited in a long time. Khan said providers can identify those patients by querying the DiagnosisOne data warehouse and can easily customize reports on a wide range of parameters.

Reaching out to patients who require services is another challenge for providers. Allscripts provides communication and patient education capabilities through its patient portal, Shapiro noted. In addition, he said, the company is experimenting with text messages to notify patients when they have an alert on the portal.

"None of these tools is a substitute for the judgment of a physician," Shapiro emphasized. "Ultimately, providers are the ones who will make patient care decisions based on their training and their relationship with the patient. But giving them the opportunity to understand evidenced-based rules, population health measures and guidelines from their own organizations or payers will allow them to make more informed decisions."

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