The Rules of Engagement

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Mary Stevens, editor of CMIO

The spotlight will be on clinical decision support (CDS) at HIMSS11 later this month, reflecting its increasingly prominent place in meaningful use requirements as well as quality improvement.  

It’s difficult to discuss CDS without talking about EMRs and EHRs—in the HITECH view of the world, EHRs will drive CDS via CMS-defined required objectives and goals.

Stage 2 will expand the requirements for CDS in EHRs, said David A. Collins, MHA, HIMSS director of healthcare information systems. “CMS loosely defined what a CDS rule was. They did so purposely,” he said. That leeway might build flexibility into the requirements for meaningful use, but it also leaves plenty of room for questions. Physicians know that “CDS is a key component to the real value that you can get out of these systems, whether it be CPOE or any process. That all ultimately does tie back to the safety of medication ordering, or procedures or reminders.

“CDS is getting a lot of attention and people need more education to understand: What’s the secret sauce? How do I effectively roll this out, get buy-in and tweak it so it works?” he asked.

No wonder, then, that a four-hour pre-HIMSS Workshop on CDS, “Clinical Decision Support Workshop: You Can't Have One Without the Other - Practical CDS & Quality Improvement,” slated for Sunday, Feb. 20, had to be expanded to accommodate additional registrants.

Key to CDS' success will be customization and integration into the clinical workflow, Collins said. At the show in Orlando, the Office of the National Coordinator for Health IT (ONC) will host sessions that provide more clarity regarding what CDS is when it comes to meaningful use. “It’s more than just research articles; it’s stuff that you can use and apply … CDS is such a core element of a successful use of EHR and other affiliated health IT, to optimize patient safety and quality of care.

“Providers do need the help, the prompts. What’s being pushed right now, as well, is [alert] plus suggested guidance. Physicians may or may not pay attention to alerts, but if it has suggested guidance, that is actionable steps, CDS is even more valuable,” Collins said.

The other piece of CDS that’s coming to light, beyond alerts and reminders, is the increasing capability of the EHRs themselves. “You’ve got the ability for clinical guidelines, you have order sets, data reports, dashboards—that’s where you’re really getting the power, as real-time CDS at the point of care, not as retrospective claims data six months after the fact,” he added. “If you can get real-time dashboard decision data in front you, that helps cross the continuity of care spectrum and care coordination. You’ve got the best information in front of you to make the best decisions possible.

The questions that need answering to optimize CDS are familiar ones, he said: ‘What makes sense for the needs of your organization, the way your docs practice medicine, the type of services you provide? And how does the culture there need to fine-tune the CDS for it to be most effective?’ Evaluating what is rolled out and providing that feedback to providers is also very important to buy-in and continued use and expansion. That’s so analogous to general successful EHR implementation.”

HIMSS11 attendees can get these questions answered at any of the 16 CDS-specific sessions at the show, which range from “Practical Pearls for Improving Outcomes with CDS” to “Creating Innovative CDS Bridge Strategies While Journeying to HIT Adoption” and more. If you’re not going to HIMSS11, check out’s daily coverage from the show floor for insight into CDS and the other hot topics in Orlando.

Mary Stevens,
Editor of CMIO