Decision Support Software Matures
August 2005
Decision support technology at Northwestern Memorial Hospital in Chicago helps trigger bug/drug alerts. No, it's not a warning about pill-popping mosquitoes. It's an electronic caution generated by a decision support system in the 725-bed hospital's health care epidemiology and quality department.
The alerts are drawn from lab and pharmacy information systems and a computerized physician order entry
application.
They "fire" for various reasons. Sometimes a physician prescribes a drug that doesn't fit the entire range of a patient's health risks. Other times, the attending physician doesn't know a patient has developed some type of infection that calls for a new drug therapy.
Either way, the system sends an electronic alert to the inbox of an epidemiologist like Gary Noskin, M.D. "One of our team then alerts the physician managing the patient and asks `did you know that?' Usually they didn't," Noskin says.
Northwestern Memorial Hospital's clinical executives decided only physicians involved with infection control would use the clinical decision support software, from TheraDoc Inc., Salt Lake City.
The hospital already had deployed enterprisewide CPOE and online documentation and notes systems, so "overlaying another system on top of those would not help clinicians make efficient use of their time," Noskin notes. "We thought it would be better to use a core of pharmacists and physicians to serve as intermediaries when an alert occurs."
Many approaches
Northwestern Memorial's plan to restrict the technology to one department illustrates how implementations of clinical and administrative decision support systems are as varied as the concept, experts say.
Decision support as a concept has fluid boundaries (see story, page 26). In the narrowest sense, it includes software that analyzes clinical, financial and administrative data. The results can be used to develop patient care or administrative guidelines and can be delivered in real time to the point of care or incorporated into larger data analysis tasks.
More broadly, decision support can mean a single application or multiple information systems, such as lab, pharmacy and radiology, feeding a data warehouse and populating analytic software. The results can be standing or ad-hoc reports delivered to caregivers or administrators and used to develop or adjust clinical or business strategies.
Use of decision support systems in health care is moving forward fitfully, experts say. Payer organizations have led the way, says Dave Garets, president and CEO of HIMSS Analytics, Chicago, a subsidiary of the Healthcare Information and Management Systems Society charged with researching use of I.T. in health care.
"Payers have done a lot more than providers in the decision support arena, including data warehousing, data mining and business intelligence," Garets says. "Until a couple of years ago, you couldn't cite a provider organization with a legitimate data warehouse, with data mining and neural networks. Most had glorified cost accounting systems running reports and they called it a data warehouse."
The 2005 HIMSS Leadership Survey, sponsored by Dearborn, Mich.-based Superior Consultant Co., notes a steady, if unspectacular, interest in decision support among provider organization respondents. Superior is a unit of Dallas-based Affiliated Computer Services Inc.
In this year's survey, 37% of health care executives said point-of-care decision support applications would be among the most important to implement during the following two years. Thirty-eight percent said the same thing in the 2004 survey.
However, decision support software is standing in a long line. Seven other applications-led by electronic medical records and bar-coded medication management systems-were rated more important by survey respondents, revealing that decision support applications are not a top priority.
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