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December 2009

In this Issue:
Clinical Decision Support at the Point of Care

Welcome to the December 2009 issue of HIMSS Clinical Informatics Insights, which highlights the effective integration of informatics across the continuum of care and the improvement in clinical quality achieved through the development and support of health IT practices, policies and end-user tools. This issue’s focus is Clinical Decision Support at the Point of Care and includes a special feature titled Show Me the Evidence. Be sure to check out this month’s Tool Box Picks and Join the Discussion features.

State of the Industry

Achieving Meaningful Meaningful Use:
What it has to do with CDS and why failure is not an option

By Jerome Osheroff, MD, FACP, FACMI

“By focusing on ‘meaningful use,’ we recognize that better healthcare does not come solely from the adoption of technology itself, but through the exchange and use of health information to best inform clinical decisions at the point of care.” –David Blumenthal, MD, MPP1

As of this writing, the U.S. healthcare system eagerly awaits regulations that define the exact requirements necessary to achieve meaningful use of clinical information technology. The stakes are high for hospitals and office practices. Substantial meaningful use bonus payments are available over the next several years, and in 2015 (and thereafter) there are penalties for not achieving such use. Care delivery organizations are busily creating checklists 2 to map their infrastructure to the available meaningful use matrix3 and health IT vendors are likewise reaching out aggressively to the market to help support these efforts.4

In the midst of this meaningful use frenzy, it’s important to step back and examine thoughtfully what’s going on and what care delivery organizations should do in response. The quote above from the National Coordinator for Health IT is a great starting point for this exploration. Consider what “better healthcare” means, and what it takes to achieve it through “the use of information to best inform clinical decisions at the point of care.”  Keep in mind evidence supporting his assertion technology alone will not deliver the essential improvements in care quality,5,6or cost.7 

These explorations point beyond the meaningful use checklist to a realization success under the new rules of healthcare delivery will involve much more than checking off each box on the 2011 requirements lists. Meaningful meaningful use requires thinking ahead to the 2015 targets and their implications (“Achieve minimal levels of performance on quality, safety and efficiency measures”). This imperative sounds familiar – what is driving it?

Thoughtful observers recognize the business importance of improving healthcare outcomes by fully leveraging health IT and other approaches predates the HITECH act by many years. The Institute of Medicine’s landmark work8 characterized profound problems with care delivery and potential solutions. It was a rallying cry for the healthcare industry, which has responded with an array of business drivers for improving care delivery processes and results. The force these drivers exert on providers is rising sharply, and meaningful use requirements are just the latest manifestation of this pressure.

These drivers include pay for performance (P4P)9, pay for reporting10, non-payment for healthcare acquired conditions,11 and national patient safety goals tied to accreditation,12 among others. The National Priorities Partnership13 encompasses a broad spectrum of key stakeholders who are identifying national healthcare improvement priorities to help focus and accelerate these various efforts; the priorities they have identified were chosen to underpin the meaningful use requirements.3

Where are U.S. healthcare providers today on this journey to harness people, process and technology to deliver healthcare that is of measurably higher quality, efficiency and cost-effectiveness? Not very far, on average.14,15 And not just because there is limited diffusion of important underlying information systems.16 Of greater concern is the somewhat paradoxical observation that for many organizations, this journey does not appear to be a top priority.17 It’s clear though that in the coming years – as we get closer to 2015 – “Achieving minimal levels of performance…” on a substantial and growing number of targets will be as hot a topic as meaningful use checklists are today.

The quote from Dr. Blumenthal above highlights clinical decision support (CDS) as a central requirement for meaningful use and for improving care. Organizations often struggle to deploy CDS successfully; nonetheless, there’s convincing evidence when executed well, significant performance benefits can be realized.18 Diverse stakeholders are collaborating to synthesize and disseminate best practices for delivering CDS effectively,19 and these critical success factors resonate with broader wisdom about performance improvement efforts. These practices include:

  • Clearly defining priority improvement goals and objectives, taking into account external drivers and internal circumstances
  • Developing and executing a thoughtful improvement plan that fully leverages available resources. Doing this with those whose activities underpin better outcomes, not to them
  • Paying very careful attention to evaluation and measurement: what is the baseline performance targeted for improvement? What improvement strategies have been implemented? How have these affected work processes? Stakeholder satisfaction? Outcomes?

So what, if anything, should healthcare delivery organizations be doing today about this unfolding performance improvement tsunami? Here are some suggestions and related questions for their leaders and others to ponder.

  • Take a step back and consider the various and accelerating performance pressures on the organization, and their implications for strategy and priorities
    • Are these pressures being tracked in a coordinated way to reveal an integrated “big picture” of all the performance improvement imperatives?
    • Is the response coordinated and fully leveraging available resources? Are governance structures and execution processes in place to refine and strengthen this response as the improvement drivers intensify over time? 
  • Revisit the "meaningful use checklist" in light of above
    • Does the current plan to deploy and use information systems and tools on the checklist help bring the organization closer to what the performance improvement demands in the coming years are likely to require?
    • Can/should the near-term meaningful use (and related) efforts be modified in light of the types of performance challenges that this infrastructure will need to address in the coming years?
  • Reread the quote from Dr. Blumenthal above and consider how organizational strategies are poised to inform decisions and deliver “better healthcare”
    • Are organizational initiatives around CDS aligned to support near- and long-term requirements related to meaningful use, and monitor/enhance CDS intervention effects?
    • Would it be helpful for the organization to participate in the emerging HIMSS Wiki-based community20 that is exploring these issues within and across care delivery organizations?

In the best of times, these forward-looking activities would be difficult and resource intensive. Clearly these aren’t the best of times, and many organizations are already struggling under current challenges. Nonetheless, taking some fraction of the time and effort being devoted to meaningful use, and applying it to understanding and achieving truly meaningful meaningful use, will likely yield handsome returns. In any case, failing to rise to growing demands for performance improvement will not be an option.

Jerome Osheroff, MD, FACP, FACMI, is chief clinical informatics officer in the Healthcare and Science business of Thomson Reuters.

References:
1A Message from Dr. David Blumenthal, National Coordinator for Health Information Technology. 10/1/09. http://healthit.hhs.gov/portal/server.pt?open=512&objID=1350&parentname=CommunityPage&
parentid=5&mode=2&in_hi_userid=11113&cached
2 For example, as evidenced by frequent online conversations on the topic via listserves for organizations such as AMDIS, a membership society for information system medical directors (http://amdis.org)
3Health IT Policy Council Recommendations to National Coordinator for Defining Meaningful Use
Final- August 2009. http://healthit.hhs.gov/portal/server.pt/gateway/PTARGS_0_10741_888532_0_0_
18/FINAL%20MU%20RECOMMENDATIONS%20TABLE.pdf
4Appleby C.  How HIT vendors are responding to meaningful use. Scottsdale Institute Inside Edge. 10/09 www.scottsdaleinstitute.org/Documents/IE/InsideEdge.2009-09.Vendors-And-Meaningful-Use.pdf
5 Linder JA et. al. EHR use and the quality of care in the US.  Arch Intern Med. 2007;167(13):1400-1405. http://archinte.ama-assn.org/cgi/content/abstract/167/13/1400
6 Nebeker JA et. al. High rates of adverse drug events in a highly computerized hospital. Arch Intern Med. 2005;165:1111-1116. http://archinte.ama-assn.org/cgi/content/abstract/165/10/1111
7 Himmelstein DU et. al. Hospital computing and the costs and quality of care: a national study.  Health Affairs. 2009. www.amjmed.com/webfiles/images/journals/ajm/AJM10662S200.pdf
8 See, for example, Crossing the Quality Chasm series: www.iom.edu/en/Reports/2001/Crossing-the-Quality-Chasm-A-New-Health-System-for-the-21st-Century.aspx
9 For example Bridges to Excellence (http://bridgestoexcellence.org), among many others
10For example CMS’ PQRI (www.cms.hhs.gov/pqri) and RHQDAPU (www.cms.hhs.gov/HospitalQualityInits/08_HospitalRHQDAPU.asp#TopOfPage) programs, with increasing numbers and types of reportable measures being added
11 For example, the growing list of conditions that will not be reimbursed by CMS: www.cms.hhs.gov/apps/media/press/factsheet.asp?Counter=3042
12 2010 National Patient Safety Goals.  The Joint Commission. www.jointcommission.org/patientsafety/nationalpatientsafetygoals
13 See National Priorities Partnership website: www.nationalprioritiespartnership.org, especially the “Priorities” tab
14 Schoen C et. al. A Survey of Primary Care Physicians in 11 Countries, 2009: Perspectives on Care, Costs, and Experiences. Health Affairs. 11/09 www.commonwealthfund.org/Content/Publications/In-the-Literature/2009/Nov/A-Survey-of-Primary-Care-Physicians.aspx
15 Kelley R. Where can $700 Billion in waste be cut annually from the US healthcare system?  Thomson Reuters 11/09. http://img.en25.com/Web/ThomsonReuters/WASTEWHITEPAPER_FINAL11_3_09.pdf
16Davis MW. The state of US hospitals relative to achieving meaningful use measurements.  HIMSS Analytics. 2009. www.himssanalytics.org/docs/HA_ARRA_100509.pdf
17Jha AK, et. al. Hospital governance and the quality of care. Health Affairs. 11/09. http://content.healthaffairs.org/cgi/content/abstract/hlthaff.2009.0297v1
18 Osheroff et. al.  A roadmap for national action on clinical decision support. www.amia.org/inside/initiatives/cds
19 See, for example, the HIMSS Clinical Decision Support Guidebook Series: www.himss.org/cdsguide
20http://himssclinicaldecisionsupportwiki.pbworks.com/CDS-and-Meaningful-Use-Home-Page - see, for example, unfolding discussions around CDS strategies for ensuring elderly patients don’t receive inappropriate medications, that problem lists are effectively developed and maintained, and that all appropriate patients receive VTE prophylaxis.

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Special Feature!

Show me the Evidence

By Amy Berlin, MD

The case for clinical decision support systems (CDSS) is compelling. Each year, thousands of patients die because of medication errors and other preventable adverse drug events. Many more patients miss important preventive care milestones, putting them at risk for premature illness or death. Among health IT enthusiasts, it is practically taken for granted that CDSS, by putting evidence-based information at clinicians’ fingertips, can dramatically improve patient outcomes.

While intellectually (and clinically) appealing, this presumption has itself only the shakiest of evidence bases on which to stand. Systematic reviews of CDSS pool systems with widely varied functionality and workflow, and deliver conclusions such as “the majority improved diagnosis, preventive care, disease management, drug dosing or drug prescribing.” This is encouraging but it is the IT equivalent of pooling studies on anti-hypertensives regardless of mechanism of action and concluding they “usually” work. More finely tuned studies, such as a recent Cochrane review of CDSS providing “on-screen, point of care computer reminders” have identified small margins of improvement in CDSS-assisted care (see also this 2008 Journal of General Internal Medicine study). Even in studies showing more favorable margins, the link between CDSS-powered clinician performance improvements and improved patient outcomes has yet to be convincingly demonstrated.

None of this should come as a surprise if we recall the ways in which our own decisions are rarely influenced by information alone. Decision making is by nature a complex and variable human activity; clinical decision making even more so. What the current evidence base lacks is clarity about the mechanics of clinical decision making and the factors – be they in the clinical environment, the technology or the particular decision being targeted by the CDSS – most conducive to CDSS-induced quality improvements.

Answers to these questions are beginning to emerge, as in a 2005 British Medical Journal study that identified “four features strongly associated with a decision support system’s ability to improve clinical practice:

(a) decision support provided automatically as part of clinician workflow,
(b) decision support delivered at the time and location of decision making,
(c) actionable recommendations provided, and
(d) computer based”

These encouraging – and intelligible – findings provide a template for further scientific inquiry into the “who, what, how, where, when and why” of CDSS. As the authors of this informative study conclude, “The promise of evidence-based medicine will be fulfilled only when strategies for implementing best practice are rigorously evidence-based themselves.”

Amy Berlin, MD, is a psychiatrist and informatics consultant in private practice in San Francisco, Calif. She is on the volunteer clinical faculty at University of California San Francisco.

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Strategies for Success

Partners HealthCare Information Systems and the Clinical Decision Support Consortium

By Patricia C. Dykes, RN, DNSc

Evidence-based practice has been defined as “the process of shared decision making between practitioner, patient and others significant to them based on research evidence, the patient’s experiences and preferences, clinical expertise or know-how, and other available robust sources of information” (Sigma Theta Tau, International, 2007).1 A foundational principal at Partners HealthCare Information Systems (PHS) in Boston is clinical decision support (CDS) is a prerequisite to evidence-based practice. To this end, PHS has been designing systems with CDS capability for use across PHS sites for decades including the Longitudinal Medical Record (LMR), the Patient Gateway patient portal, Provider Order Entry (POE) and the Electronic Medication Administration Record (EMAR) applications.

In recent years, it has become apparent true evidence-based practice beyond the healthcare system level is only possible with widespread adoption of organization and platform independent CDS tools and services both at PHS sites and across healthcare systems worldwide. To this end, Blackford Middleton, MD, MPH, MSc, FACP, FACMI, FHIMSS, corporate director at PHS and assistant professor of medicine at Brigham and Women’s Hospital, Harvard Medical School, along with a team of clinical investigators, scholars, informaticists and health IT professionals have formed the Clinical Decision Support (CDS) Consortium. The CDS Consortium is supported by a contract from the Agency for Healthcare Research and Quality (AHRQ) and aims to create and disseminate CDS tools and services in electronic health records used in academic settings and in community-based practices. The goal of the CDS Consortium is to assess, define, demonstrate, and evaluate best practices for knowledge management and clinical decision support in health IT at scale – across multiple ambulatory care settings and EHR technology platforms.2

Perhaps what is most astounding about the CDS Consortium is the enthusiastic participation from academic, healthcare, health IT and vendor communities from across the country including the Regenstrief Institute, Veterans Health Administration, University of Texas School of Health Information Science, Oregon Health Sciences University, Kaiser Permanente, NextGen, Siemens Medical Solutions, GE Healthcare, The Mid-Valley Independent Physicians Association, and the University of Medicine and Dentistry of New Jersey. Through the CDS Consortium, people from all participating organizations are working together first to define and then to disseminate best CDS practices. The work of the CDS Consortium will ensure in the future, all healthcare organizations have access to the same research evidence and decision support rules. Therefore, securing patient access to “evidence-based practice” and ensuring all clinicians participate in building and sharing evidence from their own practice.

Patricia C. Dykes, RN, DNSc, is corporate manager nursing informatics and research
Partners HeathCare.

References:
1 Sigma Theta Tau International 2005-2007 Research and Scholarship Advisory Committee. Sigma Theta Tau International Position Statement on Evidence-Based Practice February 2007 Summary. Worldviews on Evidence-Based Nursing, Second Quarter 2008, p. 57.
2http://www.partners.org/cird/cdsc

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Meet an Informaticist

Anne M. Bobb, RPh
Clinical Informatics Pharmacist
Northwestern Memorial Hospital

Anne M. Bobb earned her bachelor’s of science in pharmacy from the University of Rhode Island, School of Pharmacy and has over 15 years of experience as a clinical staff pharmacist. Previously part of a multidisciplinary patient safety team, Ms. Bobb has studied medication errors and since 2003 has focused on safe design of medication orders and order sets within a computerized practitioner order entry system and the use of clinical decision support to improve patient outcomes. Her current role is an informatics pharmacist in the Department of Quality and Clinical Informatics at Northwestern Memorial Hospital in Chicago where she works to optimize clinical information system design, workflow and integration as well as promote optimal use of clinical decision support. Ms. Bobb is a member of the American Society of Health-System Pharmacists and currently serves on the Section of Pharmacy Informatics and Technology Executive Committee as a director at large. She is also a member of the American Medical Informatics Association and HIMSS. Her research interests include optimal deployment of clinical decision support to improve patient outcomes with a focus on medication decision support.

1. What skill sets do you find of most value?
I believe clinical experience is a significant asset for my current role in informatics. Whether physician, nurse or pharmacist, a trained clinician who has some frontline experience can listen and understand caregiver perspectives and workflows more effectively than a non-clinician. Second, experience or formal training in patient safety, clinical quality or human factors is valuable for informatics. While technology is the tool used to deliver CDS, the clinical outcome must be measured from the patient’s perspective. Beyond education, skills in both change management and process improvement facilitate the significant workflow shift necessary to implement an EHR with decision support.  Above all, this job requires excellent interpersonal skills with the ability to engage and influence organization leaders, employees and physicians in the joint mission to improve outcomes with technology.
 
2. What professional advice would you share with your peers?
When implementing CDS, take the time to learn from the literature and do not hesitate to call on your peers in other organizations when you need advice.  There are two different CDS frameworks that I use frequently when planning for CDS and again during the process of pre and post assessment of that CDS. The first is from the HIMSS guide, Improving Outcomes with Clinical Decision Support: An Implementer's Guide and speaks to the ‘CDS Five Rights’ of the right information to the right person in the right CDS intervention format through the right channel at the right time in workflow. If you nail these, you have a better chance of success. The second framework that I commonly use is the Ten commandments for effective clinical decision support. This one paper is chock full of lessons learned and those lessons continue to prove true with every implementation (new technology or CDS) that I have taken part in.

3. What is the biggest challenge you have faced as an informaticist?
The most significant challenge once the EHR is implemented is keeping up with the voracious appetite for enhancements and addition of decision support and ensuring the requested change has the clinician buy in necessary for an improvement in the outcome. CDS is an obvious answer when trying to affect change in daily patient care, but fitting that CDS into clinicians’ workflow is the key to success. The request to deliver decision support is often oversimplified in the thinking that changing the electronic system or adding an alert will make clinicians do the right thing every time. CDS is simply a tool to help clinicians make good decisions.

4. What has been your greatest success or organizational outcome?
Our greatest organizational success is that we got most of the basics right and are now positioned to hopefully meet ‘meaningful use’ criteria in year one. We have had the benefit of following the pioneers in both CPOE and CDS, and have learned enough from the literature to implement wisely. During our staged CPOE implementation, we focused on the basics of clinician acceptance by providing fully defined order sentences and evidence-based order sets to make it easy for clinicians to do the right thing. We have gradually added decision support including alerts and warnings, but our early focus on user acceptance was key to ensuring we have an avenue (EHR/CPOE) to provide the decision support to the provider at the point of care.

5. What do you see happening in the next two years for CDS?
The literature shows alerts are not always effective in changing physician behavior to the point of improved patient outcomes. In the next two years, we will get smarter about the human computer interface and improve our success rate of providing the right information to the right provider at the right time. In particular, we will see physicians using ‘patient level dashboards’ that provide a relevant data display about the patient and perhaps evidence about the disease state or suggestions on current medications. These same tools will also be used for the critically important transition in care handoff. For healthcare clinicians such as pharmacists, surveillance systems will help identify and target untreated indications such as DVT prophylaxis and discrepancies in therapy that can lead to adverse drug events. Finally, supported by the ARRA ‘meaningful use’ criteria, there will be continued efforts around engaging the patient with CDS tools that can be delivered through personal health records.

6. Do you have advice specific to CDS operational excellence? Any best practices you want to share?
I believe the best CDS advice available in one place is the result of many experts collaborating on, Improving Medication Use and Outcomes with Clinical Decision Support: A Step-by-Step Guide. Though the details focus on medication decision support, the broad concepts can and should be used for all CDS.  Briefly, these concepts include building the foundation by defining priorities and baselines, consider workflows and all stakeholders, leverage available clinical information systems, optimal deployment, measuring results and refining the program and finally CDS knowledge management.

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Resource in Practice

Evidence-based Plans of Care: A Solution to Save Hospitals Time and Improve Patient Care

By Patricia S. Button, EdD, RN

Now that evidence-based clinical decision support has become widely recognized as a key component of delivering quality patient care, hospitals and health systems are seeking the most effective solution for delivering best-practice information at the point of care in a usable, actionable format. Interdisciplinary teams have achieved measurable improvements in the quality, safety and efficiency of patient care by using evidence-based plans of care.

Organizations using evidence-based interdisciplinary plans of care have demonstrated measurable improvements in key quality indicators such as the rates of surgical site and VAP infections, the frequency of pain reassessment and the rates of serious falls.1

Unlike self-developed or other unproven clinical decision support tools, evidence-based plans of care have their foundation in literature related to key medical conditions, procedures, and patient problems, which are summarized and assessed to form the basis for defining the plan. Organizations can use these plans to access the most current research and performance measures while they practice, whether in an interactive PDF format or embedded in an EHR system.

In addition to improvements in patient care, users can gain efficiency by implementing proven plan-of-care solutions that offer customization features. PinnacleHealth was able to reduce the amount of time required to develop a plan of care from months to just hours by using a robust evidence-based library of interdisciplinary plans of care in a content management system, streamlining the customization and clinical collaboration process.2

Evidence-based plans of care are a key component of fundamentally improving practice at the point of care, providing the interdisciplinary team with unified goals and supporting consistently high-quality care.

Patricia S. Button, EdD, RN, is chief nursing officer at Zynx Health.

References:
1 Rosemary Kennedy, Sheri Matter, Linda Geisler, Gail E. Latimer. Raising the Bar on the Clinical Documentation Process by Implementing Computerized Plans of Care. Siemens Medical Solutions USA, Inc. 2009. Available at: www.medical.siemens.com/siemens/en_US/gg_hs_FBAs/files/IT_Solutions_And_
Consulting/RaisingtheBarontheClinicalDocumentationProcess_Webcast_4-30-09_Final.pdf
2 Sheri Matter, Cindy Brown, Patricia S. Button, and Rosemary Kennedy. Pinnacle Health / Zynx Health / Siemens Medical Solutions A Study of Integration of Evidence Based Nursing Content. AMIA Annu Symp Proc. 2006; 2006: 1182–1184. PMCID: PMC1839490; Available at: www.ncbi.nlm.nih.gov/pmc/articles/PMC1839490

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HIMSS News

Gregory L. Alexander, RN, PhD, MHA, Shares Insight on Role of HITSP in Informatics

Be sure to view this month’s HITSP News, a monthly e-newsletter that provides news on the activities of the Healthcare Information Technology Standards Panel. Gregory L. Alexander, PhD, MHA, RN, HITSP Care Management and Health Records Domain Technical Committee co-chair will share his feedback on the role and impact of standards harmonization on the informatics space. 

HHS Announces Plans to Make $80 Million Available to Support Health IT Workforce

The Beacon Community Cooperative Agreement Program provides funding to communities to build and strengthen their health IT infrastructure and exchange capabilities to demonstrate the vision of meaningful health IT. The Curriculum Development Centers will provide $10 million in grants to institutions of higher education (or consortia thereof) to support health IT curriculum development. Community College Consortia to Educate Health Information Technology Professionals seeks to rapidly create health IT education and training programs at Community Colleges or expand existing programs. Community colleges funded under this initiative will establish intensive, non-degree training programs that can be completed in six months or less. Visit the new Supporting the Health IT Workforce from the HIMSS Nursing Informatics Community which includes several up-to-date links on: Grants & Programs from federal agencies and Competencies & Skills Sets from the TIGER Initiative and HIMSS.

Explore HIMSS10 Symposia

HIMSS10 Symposia offer specialized education for diverse and growing audiences within the health IT industry. Held before HIMSS10 commences in Atlanta on Saturday, Feb. 27, and Sunday, Feb. 28, Symposia address the educational needs of nurses, physicians, pharmacists, clinical engineers, payers, IT professionals and those involved in health information exchanges (HIEs), personal health records and the finance or supply-chain management aspects of healthcare. Let’s take a look at some of the programs:

The full-day Nursing Informatics Symposium: Realizing the Promise of Health IT for Nursing on Sunday, Feb. 28, brings together a dynamic platform of nurse leaders to address current nursing informatics issues. Attendees will learn how to position themselves for implementation success and how to demonstrate the value of health IT in the nursing world. Prior to the start of the Nursing Informatics Symposium, the half-day Foundations of Nursing Informatics: Achieving Meaningful Use and the Impact on Nursing (separate fee required) on Saturday, Feb. 27, will provide a nurse-focused interpretation of meaningful use of certified EHRs for 2011. Discussions will provide insight on the impact of standards and certification on EHR systems, implementing SNOMED CT® to achieve meaningful use and demonstrating meaningful use through quality measures.

Download the Nursing Informatics Symposium Brochure.

The full-day Pharmacy IT Symposium: The Road to Implementation—At a Crossroads of Decisions, Integration and Patients on Sunday, Feb. 28, is for pharmacists looking to maximize and develop their role in IT. With the current proliferation of EHRs and systems in healthcare, pharmacists need the skills and know-how to lead the change in their profession now more than ever. This symposium will address a spectrum of patient-centered approaches—from federal initiatives, current legislation and research, emerging disciplines and health systems’ practical approaches to improving the quality of care.

The highly-acclaimed, full-day Physicians' IT Symposium: What it Means to be a Meaningful User on Sunday, Feb. 28, will examine planning, implementation, workflow, vendor guidance and legal aspects of the EHR. After this symposium, attendees should be better able to: discuss the meaningful use criteria related to patient privacy, clinical information exchange and public health organizations; describe malpractice implications in using EHRs, PHRs and HIEs; and ask vendors questions before implementing EHRs in order to comply with meaningful use criteria.

Download the Physicians' IT Symposium Brochure. 

New this year, the half-day Personal Health Records Symposium: Are You Ready for Personal Health Records? on Sunday, Feb. 28 will take a real-world look at best practices and lessons learned from a wide range of perspectives—from small or large practices to a payer organization. Additionally, sessions explore the impact of standards, policy and meaningful use requirements for PHRs.

More information on HIMSS10 Symposia and registration is available online. Symposia registrants save $100 when also registering for the full conference. This special discount applies to full, paid conference registration (Sunday-Thursday) only and is not available for students. The discount is applied automatically during the registration process. NOTE: Early-bird registration rates end today, Monday, Dec. 14, at midnight.

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Tool Box Picks

Improving Outcomes with Clinical Decision Support : An Implementer’s Guide
By Jerome A. Osheroff , MD, Eric A. Pifer, MD, Jonathan M. Teich, FACMI, FHIMSS, MD, PhD, Dean F Sittig, PhD, FACMI, and Robert A. Jenders, MD, MS, FACP, this award-winning resource is designed to help healthcare organizations use clinical decision support (CDS) to measurably improve key healthcare outcomes such as the quality, safety and cost-effectiveness of care delivery. It is widely used by CDS implementers as the “bible” for guiding their efforts.

Ten commandments for effective clinical decision support: Making the practice of evidence-based medicine a reality
While evidence-based medicine has increasingly broad-based support in healthcare, it remains difficult to get physicians to actually practice it. Across most domains in medicine, practice has lagged behind knowledge by at least several years. The authors of this article believe the key tools for closing this gap will be information systems that provide decision support to users at the time they make decisions, which should result in improved quality of care. (JAMIA Log-in or Purchase Required)

Improving Medication Use and Outcomes with Clinical Decision Support: A Step-by-Step Guide
The result of a ground-breaking collaboration by dozens of individuals and organizations, with diverse perspectives and competencies, this guide, edited by Jerome Osheroff, MD, FACP, FACMI, and co-published by HIMSS, Scottsdale Institute, AMIA, ISMP, ASHP and AMDIS, is designed to help clinical decision support implementers improve medication use (and associated outcomes) in their organizations by providing practical recommendations for successfully implementing CDS focused on these targets.

Medication-related clinical decision support in computerized provider order entry systems: A review
Medication-related decision support is probably best introduced into healthcare organizations in two stages, basic and advanced. Basic decision support includes drug-allergy checking, basic dosing guidance, formulary decision support, duplicate therapy checking, and drug–drug interaction checking. Advanced decision support includes dosing support for renal insufficiency and geriatric patients, guidance for medication-related laboratory testing, drug-pregnancy checking, and drug–disease contraindication checking. In this paper, the authors outline some of the challenges associated with both basic and advanced decision support and discuss how those challenges might be addressed. The authors conclude with summary recommendations for delivering effective medication-related clinical decision support addressed to healthcare organizations, application and knowledge base vendors, policy makers, and researchers.

HIMSS CDS Wiki
Visitors to the wiki will find the results of nearly a year’s worth of HIMSS CDS Task Force effort, focused primarily on sharing best CDS practices for optimizing VTE prophylaxis. The Task Force hopes that new participants will find the VTE/CDS information valuable for their own efforts, appreciate that the current material is more of a beginning than and endpoint, and participate actively in refining and expanding it. Be sure to check out the HIMSS CDS Fact Sheets, CDS and Meaningful Use and Problem Lists and Meaningful Use and CDS sections of the wiki.

The Roadmap for National Action on Clinical Decision Support
The Roadmap for National Action on Clinical Decision Support recommends a series of activities to improve CDS development, implementation and use throughout the United States to help enable improvements in health, and the quality, safety and efficiency of healthcare delivery.

Join the Discussion

Check out and participate in the following discussion on the HIMSS Linkedin Group; you have to be member of the group to comment and read the discussions.

What do you think is the greatest achievement in health IT in 2009?

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