The Meaningful Use Notice of Proposed Rulemaking included clinical decision support rules as one of the objectives providers must implement. More emphasis on using CDS capabilities from EHRs and EMRs is something that Robert Murphy, MD, chief medical informatics officer at Memorial Hermann Healthcare System in Houston is excited about and applauds.
Memorial Hermann, the largest not-for-profit healthcare system in the state serving the greater Houston community, is dialed in on patient safety and quality, and deploys healthcare IT, focusing heavily on CDS, to deliver both. "We advance healthcare IT for the purpose of patient safety and quality," Murphy said.
"Meaningful use aligns with that." While the meaningful use criteria emphasize rules and alerts, Memorial Hermann thinks of CDS in a comprehensive way, including intervention, excellent data capture, data workflow and data integration, he said.
Memorial Hermann has implemented a larger patient-safety initiative beyond healthcare IT and has been able to measure the impact of CDS in the form of risk of harm, serious safety events, near misses and good catches (where intervention has occurred). With CDS, Memorial Hermann identified 3,287 potential medical errors that were caught in the last four months of 2009. While Murphy concedes that the instances could have been caught downstream, the computer catching them earlier is reassuring.
When Memorial Hermann's Patient Safety and Quality Council looked at the data, it stimulated innovation for other problems the hospital system is facing. "We have the base system all in place now," Murphy said. "We can focus a lot on optimizing for quality and safety." Memorial Hermann is conducting analyses on the effectiveness of its interventions, including looking at physician response rates and how intervention changes their workflow, to really optimize CDS alerts, he said. Alert fatigue is a concern.
"We've turned off far more alerts than turned on," Murphy said. Customization solves that problem, but the real challenge is in how to make decisions for each hospital, he said. To that end, the 11-hospital system, which includes a network of affiliated physicians and specialty programs and services, deploys Zynx Health's evidence-based CDS content and technology as part of its toolkit for driving patient safety and quality. "This is an investment," Murphy said.
With all the work Memorial Hermann has done in the area of CDS and patient safety, Murphy said he feels the hospital system is in a "good position" to meet the CDS objective of the meaningful use criteria. In fact, the five-rule requirement is somewhat limiting, as Memorial Hermann easily has five CDS rules, he said. It's a nice place to be. Memorial Hermann has made the most of its health IT implementations.
On the HIMSS Analytics EMR Adoption Model, or EMRAM, Memorial Hermann is a Stage 5 at most of its sites. It has implemented CPOE at four of its nine hospitals, with three more in place. It has a long history of healthcare IT investment.
Still, Murphy said, "To rapidly implement as many of these features (in the meaningful use criteria) is really challenging." With what it's accomplished thus far, no doubt Memorial Hermann will rise to meet the challenge.
