Determining problem areas in need of clinical decision support and the supports themselves varies by medical specialty and should be determined by "deliberative analysis," according to a new study provisionally published this week in BMC Medical Informatics & Decision Making.
The Meaningful Use incentive program requires providers to implement CDS interventions that can improve performance on clinical quality measures. However, "[n]o framework exists to systematically assess potential CDS objectives to ensure that 1) they address the most critical gaps in care, and 2) they are clinically meaningful to the broad range of specialties participating in the Medicare and Medicaid EHR Incentive Program," the authors noted.
The researchers developed a pilot protocol using specialty panels to analyze performance gaps and CDS "opportunities" to address them in four areas: oncology, pediatrics, interventional cardiology and orthopaedic surgery. They found that different specialties identified different performance gaps, and ranked them differently.
For instance, the oncology panel labeled 15 out of 22 performance gaps as "high priority," while the pediatricians labeled 11 out of 28 performance gaps similarly. Moreover, only the oncology panel found an "abundance" of effective and workflow-compatible CDS opportunities to handle the performance gaps.
The researchers concluded that the success of the incentive program in improving quality of care will depend on whether objectives are "specified," and suggested that CDS targets be specific, but allow for allow for flexibility and a broad range of potential interventions.
Other studies have expressed concern that poorly tailored CDS would be less effective and more likely to be ignored, and that existing CDS programs, as well as the incentive program itself was geared more to primary care physicians rather than specialists.