CDS best practices from someone who 'wrote the book'

Luis Saldaña, M.D., chief medical information officer for Arlington, Texas-based Texas Health Resources, offers up tips on clinical decision support implementation in a recent interview with Becker's Hospital Review.


Register to attend FierceHealthIT's executive breakfast and roundtable discussion on Harnessing Technology and Data to Enable Accountable Care on Feb. 26 in Orlando, Fla., featuring Texas Health Resources SVP and CIO Edward Marx.


Saldaña was part of the national team of HIT experts who wrote "Improving Outcomes with Clinical Decision Support," a manual for CDS implementation.

While Texas Health Resources employs a specific vendor system for its electronic health record, Saldaña says it also has added some third-party vendors for functionalities like a drug interaction checker.

"We identified the target levels we wanted to get to, identified the specific clinician processes that may lead to a CDS intervention, mapped workflows related to that intervention and then decided where the interventions would best fit into the workflow," he says. "This was not an out-of-the-box functionality of the CDS software."

Engaging clinicians in this process is key, according to Saldaña. Don't start with a complicated system right off the bat--focus on the highest-priority alerts and functionalities first. And remember to review a CDS system's functionality from time to time to make sure it's still helping clinicians, he says.

Implementing workable CDS in real-world healthcare settings isn't that easy, though. For instance, clinical decision support reference tools still lack the level of integration necessary to provide the strategic direction that providers need, according to a January KLAS report, "Clinical Decision Support 2013: Sizing Up Point-of-Care Reference Tools." Also, a study of rule-authoring tools used to convert medical knowledge into machine-executable CDS rules across Partners Healthcare in Boston found many limitations--and frustrations.

Research to date on whether CDS actually reduces inpatient costs so far hasn't provided that evidence, according to a recent study published at BMC Medical Informatics and Decision Making.

However, in previous interviews with providers, KLAS reported a majority said CDS surveillance tools have a moderate to significant impact on clinical outcomes. That study evaluated pharmacy-focused surveillance, enterprise-wide surveillance and electronic medical record surveillance.

To learn more:
- read the Becker's Hospital Review article

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