Posted by: AllinHIT
CDS, clinical decision support, EHR, electronic health record
Last week, an extensive report by Dr. Randall Stafford of Stanford University, and Max Romano, the National Heart Lung, and Blood Institute, revealed electronic health records (EHRs) & clinical decision support (CDS) use did not improve quality of care. This was shocking news initially, until I went past the headline.
Its conclusions were derived by analyzing data from the National Ambulatory Medical Care Survey, and the National Hospital Ambulatory Medical Survey — data that is 3 years old. Noting this was the basis of the analysis, I thought of the importance meaningful use, health information exchanges (HIEs), and alternate service models ( like accountable care organizations (ACOs), telehealth, and remote monitoring) can play in improving quality.
It’s not surprising to find that individual EHRs, in their separate silos do not improve quality of care. How could they, when important personal health information (PHI) is locked away in a physician’s office, and the hospital ED doesn’t have access to them during their patient’s episodic event? How could quality be improved, when a person’s allergy to morphine is noted in their physician’s EHR but during a catastrophic event a hospital administers the drug? In both examples by having access to that data via an HIE, the hospital could improve the quality of care of those patients, benefiting all parties.
The Stafford/Romano analysis that EHR use, with CDS “turned on,” had no effect on quality was not shocking. I know many physicians ignore these plans. It would have been interesting if the surveys gather data on the CDS solutions used, and the various care methodologies in use. This would have told us if one solution was used more than another. (It would be interesting for a company like ActiveHealth to do this analysis with their Aetna patient base!) Regardless of the care plan, the reviewing of such information — as well as the act of consciously overriding the suggested care plan, and sometimes acting upon that care plan — will soon be a part of MU. I have no doubt that CDS will be go from a “menu” item, to a requirement in stages 2 & 3.
It is my hope that along with the requirements physicians are rewarded for adherence. Good pay-for-performance (P4P) plans, alignment of the physician quality reporting initiative (PQRI) with meaningful use for easier reporting, and a better consumer rating as transparency is enforced, will encourage physicians to spend the time needed to review CDS plans. This along with MU adherence and HIE connections will improve quality of care, giving the next survey a different outcome.