The Health Information Technology for Economic and Clinical Health Act (HITECH Act) outlined the adoption of electronic health records (EHRs) through Meaningful Use. The MU requirements include functional capabilities for clinical decision support rules. Any organization or provider going after MU incentive dollars are getting acquainted with decision support functionalities.
Simply described, a clinical decision support system (CDSS) is computer-based functionality designed to improve clinical decision-making. Clinical decision support functionalities have been available in EHRs for a few years. Only the more advanced, or early adopters of EHRs, have extensive hands-on experience. And in many cases, the early experiences have not all been positive…clinical decision support is often synonymous with “alerts.” Alerts are a common, simple form of presenting guidance by interrupting a workflow.
Functionally, the CDSS initiates based on trigger events and can present information in the form of instructions, suggestions, or alerts based on user data input or available data. The guidance doesn’t have to be clinical; the viewer isn’t always a clinician. Since decision support can take on many forms and provide different information in context of guidance, we use a broader and more functionally descriptive label…Care Guidance. There are many opportunities to provide guidance to the care process in behavioral health.
The challenge and opportunity is to approach the adoption of care guidance by applying the past lessons learned and making sure we don’t approach it as “putting in an alert” or “turning on a functionality” but rather designing a knowledge flow that optimizes the care process leading to improved outcomes. The mistake would be to turn on the available decision support rules without thinking about the full picture of what we call the knowledge flow.
The knowledge flow looks at the entire continuum of care and optimizes key points in the workflow and decision making towards outcomes. The opportunity is to transform the EHR platform from just recording data to a proactive system for knowledge-driven care. As caregivers proceed through their care process, capturing important data for decision throughout the workflow, key decision points that impact outcomes are identified and supported with care guidance. Care guidance is more than just helping caregivers make decisions at different points in the care delivery; it’s about ensuring the entire process of care and the multiple points for optimizing care is coordinated and integrated, driving towards desired outcomes.