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Achieving Meaningful Clinical Decision Support in a Medical Home JEROME A OSHEROFF, MD, FACP, FACMI CHIEF CLINICAL INFORMATICS OFFICER, THOMSON REUTERS FACULTY/STAFF, UNIVERSITY OF PENNSYLVANIA PCPCC Conference March 30, 2010

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Page 1: Achieving Meaningful Clinical Decision Support in a Medical Home JEROME A OSHEROFF, MD, FACP, FACMI CHIEF CLINICAL INFORMATICS OFFICER, THOMSON REUTERS

Achieving Meaningful Clinical Decision Support in a Medical Home

JEROME A OSHEROFF, MD, FACP, FACMICHIEF CLINICAL INFORMATICS OFFICER, THOMSON REUTERSFACULTY/STAFF, UNIVERSITY OF PENNSYLVANIA

PCPCC ConferenceMarch 30, 2010

Page 2: Achieving Meaningful Clinical Decision Support in a Medical Home JEROME A OSHEROFF, MD, FACP, FACMI CHIEF CLINICAL INFORMATICS OFFICER, THOMSON REUTERS

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PCMH & CDS: MEANS TO AN END

Measurably Improve Quality/Safety/Cost/ Efficiency/Satisfaction

• Accreditation

• Reimbursement– Value-based Purchasing/non-payment

– Transparency/Accountability

– Meaningful Use

Drivers are Intensifying and Consolidating!

Page 3: Achieving Meaningful Clinical Decision Support in a Medical Home JEROME A OSHEROFF, MD, FACP, FACMI CHIEF CLINICAL INFORMATICS OFFICER, THOMSON REUTERS

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“QUALITY/SAFETY” TARGETS*

3

* From meaningful use NPRM

Page 4: Achieving Meaningful Clinical Decision Support in a Medical Home JEROME A OSHEROFF, MD, FACP, FACMI CHIEF CLINICAL INFORMATICS OFFICER, THOMSON REUTERS

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EHR ≠ QUALITY

Page 5: Achieving Meaningful Clinical Decision Support in a Medical Home JEROME A OSHEROFF, MD, FACP, FACMI CHIEF CLINICAL INFORMATICS OFFICER, THOMSON REUTERS

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PERFORMANCE IMPROVEMENT:A SYSTEMATIC APPROACH

Select/ Prioritize Targets

(MU/Analytics)

Measure Baselines, Benchmark

Develop Improvemen

t Plans

Execute Improvement

s (CDS)

Re-measure

5

Page 6: Achieving Meaningful Clinical Decision Support in a Medical Home JEROME A OSHEROFF, MD, FACP, FACMI CHIEF CLINICAL INFORMATICS OFFICER, THOMSON REUTERS

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CDS DEFINITION

6

“…provide persons involved in care processes with general and person-specific information, intelligently filtered and organized, at appropriate times, to enhance health and health care” – from MU NPRM

Includes/builds on current processes…

NOT just rules and alerts…

Page 7: Achieving Meaningful Clinical Decision Support in a Medical Home JEROME A OSHEROFF, MD, FACP, FACMI CHIEF CLINICAL INFORMATICS OFFICER, THOMSON REUTERS

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GUIDANCE ON GETTING CDS RIGHT

• Co-published 4/09 by leading societies; ~100 contributors

• 2009 HIT book of the year

• Co-sponsors include AHRQ, 3 CIS vendors

• “This is not a book”

• 2005 HIT book of the year

• All-time HIMSS bestseller

• Widely used by CMIOs/others

• 10 commandments for CDS: Bates et al. JAMIA 2003

• CDS: the road ahead. Greenes ed. Elsevier 2007

HIMSS Others

Page 8: Achieving Meaningful Clinical Decision Support in a Medical Home JEROME A OSHEROFF, MD, FACP, FACMI CHIEF CLINICAL INFORMATICS OFFICER, THOMSON REUTERS

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A FORMULA FOR SUCCESS:THE CDS FIVE RIGHTSTo improve care outcomes with CDS you must provide:

• the Right Information…Evidence-based, useful for guiding action and answering questions

• …to the Right Stakeholder…Both clinicians and patients

• …in the Right Format…Alerts, Order Sets, answers, etc.

• …through the Right Channel…Internet, mobile devices, clinical information systems

• …at the Right Point in the Workflowto influence key decisions/actions

Page 9: Achieving Meaningful Clinical Decision Support in a Medical Home JEROME A OSHEROFF, MD, FACP, FACMI CHIEF CLINICAL INFORMATICS OFFICER, THOMSON REUTERS

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9

CDS INTERVENTION TYPES

• Relevant data presentation: flowsheets, surveillance

• Order creation facilitators: order sentences, sets

• Reference information: infobuttons, Web

• Unsolicited alerts: proactive warnings

• Documentation templates: patient history, visit note

• Protocol support: pathways

Page 10: Achieving Meaningful Clinical Decision Support in a Medical Home JEROME A OSHEROFF, MD, FACP, FACMI CHIEF CLINICAL INFORMATICS OFFICER, THOMSON REUTERS

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Workflow Opportunities

Page 11: Achieving Meaningful Clinical Decision Support in a Medical Home JEROME A OSHEROFF, MD, FACP, FACMI CHIEF CLINICAL INFORMATICS OFFICER, THOMSON REUTERS

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CDS PEARLS FOR MEDICAL HOMES

1. Consider CDS Basics– Define CDS broadly

– Consider CDS 5 Rights

2. Establish Foundation– Select/prioritize targets

– Establish baselines

3. Consider Workflow

4. Optimize CDS in Available Systems– EHR, Portal, Registry, Practice Management…

Page 12: Achieving Meaningful Clinical Decision Support in a Medical Home JEROME A OSHEROFF, MD, FACP, FACMI CHIEF CLINICAL INFORMATICS OFFICER, THOMSON REUTERS

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CDS PEARLS FOR MEDICAL HOMES

5. Optimize CDS for Specific Targets – Workflow analysis/CDS 5 Rights=alert fatigue antidote

6. Deploy for Max Acceptance & Value– Fully engage staff/patients

7. Measure Effects and Refine Program – Do it! (Examine intended/unintended effects; enhance)

8. Manage Knowledge Assets/Processes – Approach proactively, systematically

Page 13: Achieving Meaningful Clinical Decision Support in a Medical Home JEROME A OSHEROFF, MD, FACP, FACMI CHIEF CLINICAL INFORMATICS OFFICER, THOMSON REUTERS

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THANK YOU!

Resources• PCPCC

– Meaningful Use Meaningful Connections: http://www.pcpcc.net/content/meaningful-connections-it-resource-guide

• HIMSS Clinical Decision Support Guides– www.himss.org/cdsguide

• HIMSS CDS Task Force (VTE and Meaningful Use Projects)– http://himssclinicaldecisionsupportwiki.pbworks.com

• Jerry Osheroff– [email protected]

http://www.pcpcc.net/content/meaningful-connections-it-resource-guide
http://www.himss.org/cdsguide
http://himssclinicaldecisionsupportwiki.pbworks.com/

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