Vanderbilt CEO sees clinical decision support as key to cutting healthcare waste

Clinicians need timely information to help them make value-based choices that consider cost and quality, says Jeff Balser, MD.

If the U.S. hopes to reduce an estimated $1 trillion in annual healthcare waste, the industry must do a better job of getting information to clinicians via decision support systems so they can provide value-based care to patients, contends Jeff Balser, MD, CEO of Vanderbilt University Medical Center.

According to Balser, the largest sources of America’s healthcare waste are “unnecessary services” that would be labeled “sloppiness” in most other industries. In particular, he charges that provider organizations do not systematically manage what tests are ordered for patients and which drugs are administered. As a result, Balser believes quality and cost are not being optimized.

“The root causes are predominantly system failures in our ability to effectively communicate—not only in transmitting the key information about our patients and the care they are receiving, but also shortcomings in the decision support that clinicians need to provide care that is timely and cost-effective—within and across our healthcare systems,” Balser testified on Tuesday before a Senate health committee hearing on reducing healthcare costs.

While he made it clear to lawmakers that the drugs and tests physicians are generally ordering are not “wrong or bad” for patients, Balser made the case that “too often we fail to systematically provide timely information to help clinicians make value‐based choices.”

He gave the example of a common infection in which the “offending organism may be sensitive to as many as 10 antibiotics that are all effective, yet the range of prices for those drugs could differ by a factor of 10 or even 100—and the healthcare team often will have little information on those details.”

To address this information shortfall, Balser contends that clinical decision support systems—like the one implemented by Vanderbilt University Medical Center—can help guide physicians when choosing certain drugs or tests.

“At Vanderbilt, our pioneering efforts to develop one of the first health information systems capable of delivering this kind of information to the bedside dates to the late 1990s,” he testified. “However, we learned early on that technology alone is not sufficient to change practice. Over the years, we’ve also engaged our clinicians to help us formulate the best practice, guided by a clinician‐led pharmacy and therapeutics committee. Importantly, our clinicians can override the electronic decision support based on their view of the clinical situation.”

Also See: Vanderbilt execs say system is ready for transition to Epic platform

Balser told the Senate committee that providing the information physicians need at the point of care—through the clinical decision support and electronic health record systems as well as people and process—is yielding significant results for Vanderbilt.

“Since 2010, inpatient drug expense—even corrected for discharge volume and disease severity—has more than doubled across teaching hospitals in America that as a group perform the nation’s most complex care,” testified Balser. “Over this time, Vanderbilt has managed to hold costs well below the national median, saving about $35 million a year. Given the success, we’ve begun to expand the same practice to diagnostic test ordering—an even larger opportunity. In one example, genetic testing, we’ve already estimated that $1 million in annual costs can be saved.”

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