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Advance for Health Information Professionals • January 2017

16 ADVANCE FOR HEALTH INFORMATION PROFESSIONALS / CDS By issuing alerts at the point of care and within clinical workflow, CDS can address non-compliance issues at the point of origination. With pressing hard-stop issues, requiring clinicians to record the reason for non-compliance can have a dramatic effect on reliable adherence. Improving Radiology Compliance and Utilization In 2012—well in advance of the coming CMS mandate to involve CDS in advanced imaging orders—a large health system undertook a CDS project to improve efficiency in CT head scans for non-traumatic headache. The purpose was to reduce unnecessary CT scans without compromising care quality. This health system’s existing CDS platform was configured to reference clinical guidelines for CT scans, with prompts that functioned as compliance reminders when EMR documentation indicated a deviation from clinical guidelines. As clinicians were already familiar with the guidelines and with the CDS system itself, no training was required to support the project. Clinicians were free to ignore each alert, change the order or enter documentation supporting the order, with the CDS system recording each action. Clinical leadership reviewed periodic compliance reports with clinicians who deviated most frequently from guidelines. The project succeeded in greatly improving CT scan utilization for non-traumatic headache. Within 10 months, the rate of compliance increased from 67% to nearly 90%. As more clinicians began to comply without having to be prompted, monthly alerts fell from 339 to 198, and bypassed alerts dropped from 113 per month to 22. Duplicate scans were nearly eliminated, and unnecessary scans fell from a high of 23% to fewer than 5%. As a result, there were far fewer claims denials for imaging orders. As this project illustrates, CDS is highly effective at quickly establishing uniformity of care in target processes. Momentary lapses required only a simple point-of-care reminder to return to compliant care. The health system that launched the CT scan project has since expanded its CDS initiative to include all CT imaging for headache, chest and abdominal pain. Early metrics indicate the achievement of results similar to those in the original project. Increasing Compliance Deviations from clinical guidelines are most often a simple matter of habit. Expecting clinicians to remember guidelines on their own is an ineffective means to changing habits for multiple clinicians across an enterprise. CDS-driven compliance supported by discussion, education and reporting delivers far better results, with far greater uniformity, through automation. Development of guidelines is expensive and time consuming; focusing efforts on review and workflow decision support is much more productive for organizations. Clinical decision support can improve adherence to virtually any clinical mandates or guidelines, even as they evolve, without the need for clinicians to be fully aware of each new requirement as it is introduced. Properly directed, this unique capability can improve not only clinical outcomes for patients, but financial outcomes for provider organizations in an era when reimbursement is increasingly tied to compliance. Juliana Hart is vice president, Market Development, medCPU. RELATED CONTENT CDS and Population Health The role of rules-based clinical decision support in population health management JANUARY 2017


Advance for Health Information Professionals • January 2017
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