Clinical Decision Support Tools Deliver Benefits Beyond Improved Patient Care

Joshua Howell

The US Department of Health and Human Services (HHS) has been assertive in its push for alternative reimbursement models such as accountable care organizations (ACO) and bundled payments. Both private payers and the Centers for Medicare and Medicaid Services (CMS) are increasingly interested in achieving greater consistency of cancer care and predictability of costs. In fact, CMS has a goal of tying 85 percent of all traditional Medicare payments to quality or value by 2016.

One best practice identified for transforming quality, safety and efficiency in healthcare is the use of clinical decision support (CDS) tools. These tools provide timely, relevant information to physicians and other clinicians, as well as patients, to aid in making better informed decisions about healthcare. They can include order sets created for particular conditions or types of patients, recommendations, and databases that can provide information relevant to particular patients, reminders for preventive care, and alerts about potentially dangerous situations.

The “Right” Types of Tools

There are many reasons for physicians to embrace the use of clinical decision support tools. They can improve efficiency and safety, and they can potentially lower the costs of care. The benefits of clinical decision support tools can filter throughout the entire practice, going much deeper than the most obvious improvements to patient care.There are many different technologies and options available when it comes to clinical decision support tools. When selecting which tools to implement, practices should consider what HHS calls the “CDS Five Rights.” These “rights” provide guidance and indicate that clinical decision support tools should provide:

1. the right information;
2. to the right people;
3. in the right format;
4. through the right channels; and
5. at the right times.

Many practices today are using electronic health record (EHR) systems. Most of these systems provide some alerts that could be considered a level of clinical decision support. For example, systems often are capable of warning about potential allergies and possible interactions with medications. In oncology, however, the most value comes from clinical decision support tools that use more sophisticated logic and algorithms to provide the right information—alerts, order sets, protocols, patient monitoring, and infobuttons— according to the patient and his or her specific diagnosis. This is especially true because drug therapy is such a critical aspect in the treatment of patients with cancer.

According to the Pharmaceutical Research and Manufacturers of America, there are currently more than 770 cancer drugs and vaccines in development, and more than 3,100 clinical trials for cancer drugs being conducted in the United States. The rapid rate of innovation in oncology is exciting and promising for the future treatment of cancer, but it also presents challenges for oncologists who must keep up to date on the latest research and evidence-based treatment options available.

As new drugs, technologies and clinical trials become available, practices should be able to depend on their support tools to incorporate these updates into their logic and algorithms. Oncologists also must keep pace with personalized medicine and the use of diagnostic tests, which can be aided with the use of clinical decision support tools that have strong content and automatically update pathways and guidelines as new evidence emerges.

One oncology-specific regimen support tool, Clear Value Plus, presents physicians with Value Pathways powered by National Comprehensive Cancer Network (NCCN) and NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) within the clinical workflow. This particular support tool can integrate with a practice’s electronic health record (EHR) system to deliver relevant, evidence-based treatment options at the point of care. As Value Pathways powered by NCCN are continuously updated, those changes are incorporated into the support tool to ensure physicians have the latest information and can easily make treatment recommendations.

The importance of integrating clinical support tools with other systems within the practice cannot be overstated. Today’s oncology practices often use a wide array of technologies—EHRs, patient portals, drug inventory management systems, and many more. Each of the technologies may enhance a particular component of cancer care, but unless they are integrated with other systems, a practice will not realize the full potential of information technology.

Unintegrated, incomplete information can result in missed opportunities to increase the overall quality of patient care, maximize practice productivity and lower practice operational costs. However, when clinical decision support tools are integrated with the practice’s other technologies, the practice can solve key challenges that impact quality of care and practice efficiency. One such challenge is ensuring good communication amongst all caregivers in a patient’s care team. Patients diagnosed with cancer require care from many different types of providers ranging from their general practitioners and physicians they see for other diseases and conditions to their oncologists, pharmacists, nurses, radiologists, nutritionists, and potentially many other specialists. One of the biggest values of technology today is the ability for multiple caregivers to work from the same playbook by having access to the same information regarding a patient.

The best clinical decision support tools integrate comprehensively with other technologies to give access to patient information and even push notifications of the right information to the right people at the right time to take action. This even includes patients or their designated caregivers through patient portals.

Another common concern among physicians today is the overabundance of complications and work created by the vast number of different payer models in use. To efficiently participate in multiple programs requires sophisticated technology. Using a clinical decision support tool that is tied into a practice’s EHR can simplify the reimbursement processes and minimize exposure to denied claims. Automatically recording treatment decisions in the patient record of the practice’s integrated EHR aids in documentation adherence to evidence-based treatments. This not only confirms regimen selections are on-guideline and on-pathway, but it also minimizes the burden of documentation for prior authorization, quality reporting and compliance. It also saves significant administrator and billing staff time.

Even further, capturing information helps practice administrators negotiate quality contracts with each of their payers. It also helps fulfill the requirements of demonstrating quality, including key performance metrics such as adherence, regimen utilization history and program participation— for an individual provider, a single site or across the entire practice. As practices expand their use of clinical decision support tools, they should carefully evaluate what challenges they face and find tools that can be fully integrated within their workflows. This will ensure that clinical decision support provides the right information to the right people at the right time to trigger key decisions and actions in care.

Joshua Howell is a clinical coordinator for McKesson Specialty Health