Financial incentives for appropriately using clinical decision support (CDS) are scheduled to kick in on Jan. 1, 2018. Do you know what your plan of action is?
CDS implementation is one of the biggest topics at SIIM 2017 in Pittsburgh, and a large crowd gathered the morning of June 1 for a presentation by thought leaders Keith D. Hentel, MD, MS, of New York-Presbyterian Hospital-Weill Cornell Medical Center, and Kevin W. McHenry, MD, of the University of Texas MD Anderson Cancer Center.
The presentation, “Order Entry CDS: From Implementation to Positive Outcomes,” featured fascinating insight from both Hentel and McHenry. These are three key takeaways that stood out from their talk:
1. If you’re anxious about CDS, you are far from alone. At the beginning of the presentation, everyone was asked to answer a simple question: What is your level of anxiety related to the impact of CDS implementation at your practice? 82 percent of those who responded said their anxiety was “high” or “medium.” Another 14 percent said their anxiety was “low” and just 4 percent said they weren’t anxious at all.
Of course, that Jan. 1, 2018, deadline has already been delayed once. A second delay, which some in the industry have predicted will happen sooner than later, could relieve a lot of that anxiety. But for now, that knot that magically appears in your stomach each time you sit down to work on CDS likely isn’t going away anytime soon.
2. Radiologists should be incorporated into CDS workflow, and it doesn’t necessarily have to take up a lot of their time. Hentel discussed Weill Cornell’s experience as a qualified provider-lead entity (qPLE) responsible for its own appropriate use criteria (AUC) and said the team made it a priority to incorporate consultation with a radiologist into the various pathways.
“We’ve learned that you can’t anticipate every difficult clinical condition into these logic trees,” he said. “To do so would create multiple interactions with the ordering providers … and at the end of the day, those complex patients are better discussed person to person with a radiologist.”
Weill Cornell has designed its CDS system, Hentel explained, so that contact information for a radiologist automatically pops up when needed. And this might worry some specialists, thinking they could be bombarded with questions, but Weill Cornell set up a dedicated imaging ordering consultation service that fields these calls. Hentel added that 70 percent of the time this service is used, the order is changed to a more appropriate exam, which proves that going this route can make a real, tangible impact on patient care.
3. Always engage local leadership. McHenry noted that the necessary individuals must be consulted while developing CDS systems from scratch. Input from chief medical information officers, chief quality officers, chief medical officers and any other relevant clinical leaders is absolutely vital.
McHenry said those individuals must be provided with thorough information about the CDS legislation, the role of qPLEs and the role the facility’s data plays into actually developing the AUC. The impact of the CDS on the provider’s workflow must also be discussed in great detail, he said, adding that you can always ease into implementation by just focusing on Medicare patients if that impact becomes a concern for the provider’s decisionmakers.