Feature | March 06, 2013| Helen Kuhl

Implementation of Clinical Decision Support in the Real World

A decade of CDS experience at Brigham and Women’s

Brigham and Women’s Hospital in Boston conducted a pilot study of a Web-enabled computerized physician order entry (CPOE) system (another Stage 2 requirement) with embedded imaging decision support. In an effort to reduce the inappropriate use of medical imaging and improve quality of care, it was phased into clinical use between 2000 and 2010 across outpatient, emergency and inpatient departments. The study, published in the Journal of the American College of Radiology in February 2012, showed significant increases in meaningful use for electronically created studies (from 0.4 percent to 61.9 percent) and for electronically signed studies (from 0.4 percent to 92.2 percent) and the adoption of CPOE (from 0.5 percent to 94.6 percent).

A total of 4.1 million imaging studies were performed during the study period. The use of electronically created studies was greatest in the emergency department and inpatient settings. Meaningful use varied across specialties; surgical subspecialties had the lowest rates of electronically created studies.

“Our study shows that an imaging CPOE system with embedded decision support that is integrated into the healthcare enterprise IT infrastructure and the relevant electronic medical record platform and optimized within the clinicians’ workflow can be successfully and broadly accepted clinically,” said Ivan K. Ip, M.D., MPH, lead author of the study.   

CDS was not wholeheartily embraced by everyone at the hospital, said Ramin Khorasani, M.D., Brigham and Women’s Hospital, Harvard Medical School, Radiology, when he spoke about the software at SIIM 2012 in June. He said it took time to get people to buy in to decision support and accountability, explaining people did not want to change or do something new, especially when it’s a significant change for a radiology practice. He offered advice to hospitals looking at adopting CDS.

Khorasani said the quality of the evidence used by the CDS matters. He said Brigham & Women’s gives scores to the evidence (it does not matter who published it) to say how valuable it is, before they accept it and put it into the system. 

There are instances when there is evidence both for and against something, which can lead to confusion if entered both ways into a CDS system. “When something isn’t clear, we don’t put it in,” Khorasani said. “Then we turn to local best practices. We don’t put something in just because it’s published by one group or another. We leave controversial stuff aside.”

The system uses evidence-based guidelines from the various societies, which are updated continuously to keep the CDS current. The lag time from publication to updates in the system is between four to six weeks. 

Effective decision support also must be accompanied by accountability. Brigham & Women’s now requires physicians to sign all orders electronically.

“We are going to embarrass you, and make you think twice about ordering an exam,” Khorasani said. 

Brigham and  Women’s CDS tool is not something on the side, it’s part of the medical record, he said. Part of the reason for this is to record everything and make physicians accountable and guarantee they do not ignore clinical evidence. 

Khorasani also said a broad collaboration is needed, from those in the front lines using the system, up through to the upper management. “Adoption of evidence-based imaging health information  technology needs leadership, too. You must have buy-in and encouragement from the top in order for it to succeed,” he explained. 

Finally, he advised using the data collected by the system to measure everything.  This will help quantify successes and also identify issues that need to be addressed.   

Related Content

CareSelect Declared Fully Qualified Clinical Decision Support Mechanism by CMS
News | Clinical Decision Support| July 18, 2017
National Decision Support Company announced the full qualification of its CareSelect Platform as a Qualified Clinical...
CMS Proposes Delaying Clinical Decision Support Documentation to 2019
News | Clinical Decision Support| July 14, 2017 | Jeff Zagoudis, Associate Editor
In a series of proposed rule changes to the Medicare Physician Fee Schedule (MPFS) released July 13, the Centers for...
European Heart Rhythm Association Launches Cardiac Arrest First Responder App
News | Mobile Devices| June 30, 2017
A novel smartphone application has been developed that can direct first responders to cardiac arrest victims more than...
Sponsored Content | Videos | Clinical Decision Support| June 29, 2017
Rami Doukky, M.D., system chair, Division of Cardiology, professor of medicine, Cook County Health and Hospitals Syst
Innovative Cardiovascular Ultrasound Solutions Showcased at ASE 28th Annual Scientific Sessions
News | Cardiovascular Ultrasound| June 01, 2017
June 1, 2017 — More than 50 companies and organizations will display their latest products and services at the Americ
MIM Software Inc. Announces Updates to MIM Encore
Technology | Remote Viewing Systems| May 31, 2017
MIM Software Inc. recently announced significant updates to its MIM Encore solution for viewing nuclear medicine images...
News | Enterprise Imaging| May 25, 2017
At the 2017 annual meeting of the Society for Imaging Informatics in Medicine (SIIM), June 1-3 in Pittsburgh, Konica...
Memorial Hospital of Gulfport used a McKesson, Change Healthcare, cardiovascular information system (CVIS) to improve workflow efficiency

Memorial Hospital has increased efficiency using a single cardiovascular information management database. 

Sponsored Content | Case Study | Cardiac PACS| May 23, 2017
Located along Mississippi’s Gulf Coast, Memorial Hospital at Gulfport is a nonprofit, 445-bed facility originally est
Partners HealthCare and GE Healthcare Launch 10-year Collaboration on Artificial Intelligence
News | Artificial Intelligence| May 17, 2017
May 17, 2017 — Partners HealthCare and GE Healthcare announced a 10-year collaboration to rapidly develop, validate a
News | Information Technology| May 11, 2017
McKesson Imaging & Workflow Solutions, an industry leader in providing healthcare IT and imaging solutions, is...
Overlay Init