David Brailer, MD, former federal health IT czar and founder and chairman of Health Evolution Partners, pointed out that physician use of true clinical decision support remains a significant challenge for the industry. I spoke with Greg Dorn, MD, COO of Zynx Health Care, about CDS, and thought I'd share his thoughts and hopefully start a dialogue about what kinds of CDS we want physicians to adopt and how we can get there.
First off the bat, one of the keys to adoption is trust, Dorn said. "Clinicians have to trust what they're adopting," he said. You need to develop a transparent methodology to the literature and ensure that the data has been correctly coded, normalized and risk adjusted. Then you need to allow physicians to test the methodology to gain trust in the data's representation. Physicians need to have the flexibility to accept and reject, and customize the templates.
There are evidence-based medicine guidelines that exist in paper format that can be easily translated into electronic proxies, Dorn said. Adoption will be greater because they already trust this information. The success of the translation from paper to electronic, however, depends on using a format that the physicians trust.
CDS has increasing levels of complexity, Dorn said. He considers e-prescribing and alerts such as drug-drug interaction as "beginning steps." While all good and well, they "don’t get us to the big opportunity," he said. The bigger opportunity is in aligning CDS with best evidence-based literature, which will drive down both over- and under-utilization of healthcare services. This will help the industry as it moves toward an accountable care organization model, he said. "This is the big opportunity that will bend the cost curve," Dorn said.
As physicians implement best practices into their workflow, they'll need to understand the data and how their practice has changed, he said. The opportunity to use the data collected in their EHRs to measure performance is tremendous. Yet, there's still an adoption curve.
Some 1,700 healthcare organizations are using Zynx Health Care's solutions, with approximately 1,100 in some stage of implementation of order sets, rules, care plans and alerts, Dorn said. Case studies and research papers have been done that demonstrate real benefits. CDS is alive and well with these "early majority" institutions, he said. The CDS market, however, is still huge - especially, no doubt, thanks to ARRA and the near-final meaningful use criteria.
