Clinical Decision Support: Are We Ready to Invest?
By Jaffer Traish
Sometimes great ideas are just ahead of their time. Microsoft launched a smart watch in 2004. Digital currency received 100M in venture funding, but collapsed in the dotcom era. Google Glass has come and gone – or has it?
Evidence-based medicine and the marriage with technology is another open playground. Opportunities abound to create interactive, engaging clinician workflows to support real-time decision-making and enhance not just clinical outcomes, but the patient experience and revenue integrity.
The Hearst Corporation’s portfolio includes efforts to improve real-time medication decision support, maintain the currency of order sets and care plans, as well as drive care team and care transition communication. Wolters Kluwer is similarly working on the above, as is Elsevier in their respective product portfolios. The CMS value-based purchasing and other HITECH act incentives provide some soft carrots to push forward.
EHR vendors also provide significant clinical content (sometimes including specialties as well) that provide a very practical head start, though with no assessment of evidentiary integrity. Some startups like Stanson Health are also tackling niche areas of decision support.
The meta-analysis, categorization, and dissemination of evidentiary information is not a hard science. Teams of clinicians and coders together can review hundreds of articles and publish findings relatively quickly. Most healthcare systems have enterprise subscriptions to evidentiary libraries to consume these findings. Even as there is disagreement among communities over studies and trials, that very disagreement is the impetus for further study.
Some EHR vendors support communities of clinicians coming together to bridge the gaps in knowledge and best practice findings, especially in pediatric care.
Healthcare systems aren’t software development shops. Most don’t develop teams to tackle this opportunity. Instead, they hire analysts to manually manage the change (painful and expensive). The evidence subscription vendors have been trying, though they aren’t the EHR experts – the integration approach has been flawed. Groups like OpenCDS are refreshing and bring attention to standards development and process, though still ahead of its time. Last but not least, implementation, rollouts, ICD-10, and other priorities have taken the spotlight.
Clinicians are adjusting to their systems. Are they be ready to do focused collaboration on their (ex.) 200 order sets with evidence depth?
EHRs are maturing their decision support tools. Are they ready to participate more fully in sharing public specifications for standard decision support ingestion?
Evidence vendors have grown revenue streams on non-integrated IT tools. Are they willing to wipe the slate and start fresh with new API models?
Revenue cycle teams have been focused on SBO models, centralization, and patient satisfaction, but there is a strong link to revenue integrity with the reduction of unnecessary tests and improved standards of care. Is the CFO ready to demand this value?
In talking with many CXOs, some truly want to insource this activity while others would prefer to pay – to have content and evidence managed externally and reap the lessons and value from others. Both models could prove effective. Today, the costs are high dollar subscriptions. Perhaps these costs need to be part of a risk strategy and not paid without successful implementation.
Today, if an African American would have better outcomes with a different antibiotic, the clinician should have this information at his/her fingertips in the workflow.
Today, if a drug is removed from the market, it should be removed from the clinician’s selection in swift manner without much manual intervention.
Today, if the several major children’s hospitals wanted to jump online and compare their pediatric specialty order sets, they should be able to do so with ease and share the best.
Today, if there are 500 opportunities to improve clinical content with evidence supported changes within an organization, the CFO should know what the patient outcomes and related costs/savings may be.
The list goes on, and we can do all of this today – manually.
The challenge is not dissimilar from the interoperability debate. Just as we need a national patient identifier, adopted patient security measures, and implementation cost-sharing that includes practices, hospitals, patients and providers, the same theme can be found here. We need public specifications through collaboration, a change in the way evidentiary information is so proprietary today and closer partnerships with innovation teams.
Organizations each pay $50k-1.2M for decision support systems today in existing budgets. Various market analysis projects decision support to be a market of $550M by 2018, and upwards of $2B in the future. Let us demand more for our healthcare dollars.
Jaffer Traish is VP of the Epic practice at Culbert Healthcare Solutions of Woburn, MA.