Thinking about Clinical Decision Support (CDS)

I attended at webinar today on “Achieving Meaningful Use – The Importance of Clinical Decision Support”. Overall the information was pretty good. It wasn’t exactly new information, but it never hurts to hear something again. The webinar got me thinking about Clinical Decision Support (CDS).

CDS is a term frequently used to describe computer-based software systems capable of providing valuable information to practitioners while using a variety of applications such as computerized provider order entry (CPOE), pharmacy information systems (PhIS), medication reconciliation systems, etc. While CDS systems don’t necessarily have to be computerized, paper systems typically aren’t as efficient. CDS systems can be used to provide information on drug-drug interactions, drug-allergy interactions, drug-condition interactions, renal dosing recommendations, geriatric and pediatric rules, and so on.

Our facility utilizes the built in functionality of our PhIS, Siemens Pharmacy, to check new orders against possible drug interactions, allergy sensitivity, laboratory values, and pregnancy and lactation indicators. In addition, we run various reports for patients receiving vancomycin, aminoglycosides, and warfarin that require follow up on labs and dosing as well as reports for patients with decreased renal function requiring medication dosage adjustments.

Many CDS systems, like our Soarian system, can be used to write custom rules to help clinicians make decisions. These rules can be as simple as reminding physicians to get INR results for patients on warfarin to complex rules that analyze several pieces of information to alert the provider when there is a problem, such as the use of enoxaparin in patients with positive heparin antibodies.

Evidence based order set development can also be considered for inclusion as CDS. Systems such as Order Optimizer and ZynxOrder are content management systems for developing and maintaining various order sets, admission criteria, alerts and reminders. These content management systems can be utilized to create consistent, evidence based order sets for use in the hospital. Order set management is problematic in most healthcare systems and requires a multi-disciplinary approach involving physicians, nursing and pharmacy.

Third party vendors such as Pharmacy OneSource with their Sentry 7 product, as well as TheraDoc’s Clinical Alerts Assistant can provide valuable “after market” value to healthcare providers by monitoring several quality indicators and alerting the provider, via electronic notification, when something isn’t right.

CDS systems can provide significant value to any healthcare system. Trying to figure out which system, or systems, to use is a different matter all together. Implementation can be time consuming and costly in both dollars and human resources. The most important thing to remember is that these systems, in any number of combinations, can improve workflow and provide an additional measure of safety to patients.

For anyone interested in learning more, John Poikonen keeps an excellent resource on CDS here.