3 reasons to get serious about clinical decision support

Clinical Decision Support will be be a big part of medicine in the future. Here's why health IT should help and how to do it.

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Clinical decision support (CDS) systems are a long way from mainstream.  But they’re coming fast, and health IT has to get ready. 

On January 1, 2017, healthcare providers who order advanced imaging exams have to begin using CDS when placing their orders for Medicare patients. It’s the law, as written in the Protecting Access to Medicare Act of 2014.

The teeth behind it are more dachshund than pit bull.  But if you’ve ever turned your back on a dachshund, you know it can be a mistake.

Starting in 2017, the Centers for Medicare and Medicaid will begin tracking providers.  Those who don’t follow the guidelines for using CDS when ordering advanced imaging for Medicare patients will be identified over the next three years – based on two years of performance – and be ordered to obtain “prior authorization for applicable imaging services” for an “appropriate” period. This time there will be a bite in the pay those providers receive – or more exactly, don’t receive.

Translation: Unless you want the government forcing your providers to routinely preauthorize every advanced imaging exam they order for their Medicare patients, you’ve got 14 months to implement a CDS. 

Look at CDS as a way to empower your organization, to maintain its control over imaging utilization, by keeping third-party radiology benefits managers from getting their mitts on it. That’s number one.

In the meantime there are other reasons to embrace CDS. Number two has to do with “Meaningful Use” and the 2009 HITECH Act, which provides financial incentives for providers to adopt electronic health record systems (EHRs). 

Stage 1 of Meaningful Use, already in force, calls for the implementation of one CDS rule “relevant to specialty or high clinical priority” along with the ability to track compliance with that rule. The bar rises in successive stages.

In stage 2, providers must implement five CDS interventions related to four or more clinical quality measures. In the third and final stage, providers could be asked to implement 15 CDS interventions related to five or more clinical quality measures, according to draft recommendations submitted by the Meaningful Use Work Group. Two or more may be required in preventive care; chronic disease management;  appropriateness of lab and radiology orders; advanced medication-related decision support; and improving the accuracy or completeness of the problem list for one or more chronic conditions. Note the listing of radiology orders – another reason to pay attention to the medical imaging mandate contained in the Protecting Access to Medicare Act of 2014.

A third reason to adopt CDS is the uncertain environment for reimbursement. We've seen decades of cuts in reimbursements, not raises.  And it won’t be getting better, just different.

As value-based medicine supplants the traditional fee-for-service model of reimbursement, payments will be linked to patient outcomes. CDS offers a chance for providers to prove to insurers that they are serious about improving the care given patients.

Studies of CDS "indicate improvements in preventive services, appropriate care, and clinical and cost outcomes," writes Dr. Elizabeth V. Murphy of the Oregon Health & Science University in her paper, “Clinical Decision Support: Effectiveness in Improving Quality Processes and Clinical Outcomes and Factors That May Influence Success.”  

For those in health IT who want a leg up in the transition to CDS, the government recommends five steps:

  • Integrate CDS with an initiative to improve quality
  • Assemble a CDS implementation team
  • Match CDS to the processes and goals of the provider
  • Roll out a few high-impact CDS interventions
  • Measure their effects.

The sooner health IT professionals take these steps, the better.

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