EHRs Often Lack Clinical Best Practices

5 Key Elements For Clinical Decision Support Systems

Hospitals with electronic health records (EHRs) barely earn a passing grade when it comes to following best practices in treating heart failure and pneumonia, according to an audit by a clinical decision support content provider.

Only 62% of hospitals' EHRs included clinical processes that have been proven to reduce congestive heart failure patients' mortality, hospital readmissions, and overall costs; 67% included clinical processes for treating pneumonia. That is good for an overall grade of D or D-minus from Los Angeles-based Zynx Health, a unit of Hearst Publishing. Company officials believe the study to be the first of its kind.

Zynx announced these findings based on data it collected from 79 hospitals--not necessarily Zynx customers--and the clinical decision support (CDS) content developer continues to add facilities and medical conditions to its audit. Currently, the review includes more than 100 health systems and 47 different conditions. "It doesn't look that different at 100," compared to the 79 hospitals in the report, said Zynx Health co-founder, president, and CEO Dr. Scott Weingarten.

"We find that there are a lot of important clinical processes missing," Weingarten told InformationWeek Healthcare. For example, more than a few hospitals did not include beta blockers in their order sets for heart failure. "The results show that there are lots of opportunities for improvement," Weingarten said.

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Zynx decided to focus this report on heart failure and pneumonia because there is a high incidence of these two diseases, and they are among the conditions that the Centers for Medicare and Medicaid Services (CMS) will no longer reimburse hospitals for when patients are readmitted within 30 days of a previous discharge, according to Weingarten.

The Zynx CEO said that EHRs need CDS to fulfill their promise of improving care and reducing costs. Weingarten called an EHR by itself "like a computer without software."

Unfortunately, hospitals tend to focus first on going live with their EHRs, then they go back and seek to optimize their CDS. "Sometimes it takes them longer than they expect to do the CDS optimization," Weingarten said.

Indeed, the brand of EHR did not much matter in the Zynx survey. Among the five largest EHR vendors in the United States, none averaged better than 74% on heart failure or 73% on pneumonia, though that is more a function of how their customers used the systems than it is of the software itself. Two vendors had averages below 60%--a failing grade--with regard to heart failure.

There were some successes, however. Zynx singled out Memorial Hermann Health System in Houston for having an EHR that caught 6,513 potentially fatal errors and other "clinical flaws" in a year and saved $1.4 million by "moderately adopting" certain important clinical processes in the same timeframe. The massive organization measured compliance with the panel of 12,000 patients with six specific conditions: chest pain, chronic obstructive pulmonary disorder, gastrointestinal hemorrhage, heart failure, pneumonia, and sepsis, according to chief medical informatics officer Dr. Robert Murphy.

For the last 18 months, Memorial Hermann has compared the benefits of using order sets against the drawbacks of not having order sets that conform to established best practices. "There have been significant cost differences," Murphy told InformationWeek Healthcare. "We started to do some deeper analysis," Murphy said. "We are seeing a trend toward less mortality and fewer complications."

The health system has been engaged with clinical IT for a decade and a half. Murphy said that achieving these kinds of benefits requires good infrastructure and clinical leadership. "It's not simply installing software," he said, echoing the sentiments of Weingarten.

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