The Centers for Medicare and Medicaid Services is warning against relying too heavily on clinical decision support (CDS) pop-up alerts when meeting meaningful use Stage 2 objectives.
With the enormous amounts of patient data being generated from medical devices and electronic health records, CDS is seen as a linchpin for enabling the effective use of all of this information. As medical data and individual patient information become more readily available electronically, CDS is meant to improve quality of care and enhance outcomes by avoiding errors and adverse events, improving efficiencies, reducing costs, while enhancing provider and patient satisfaction.
This is one of the main drivers for the popularity of CDS. For the next stage of meaningful use, healthcare providers using electronic health records will need to incorporate more and more CDS into their software to qualify for incentive payments, says Bradley Merrill Thompson, general counsel for the CDS Coalition, which represents software providers, healthcare payers, providers and medical device manufacturers.
According to the Centers for Medicare and Medicaid Services, in Stage 1 of meaningful use eligible professionals and hospitals must implement one CDS rule. However, in Stage 2, EPs and EHs must implement five CDS interventions related to four or more clinical quality measures and implement functionality for drug-drug and drug-allergy interaction.
CMS advises that CDS can be provided in several ways, including interruptive activities such as pop-up alerts, information displays or links (such as InfoButton), and targeted highlighting of relevant data. While many providers may associate CDS with pop-up alerts, alerts are not the only or necessarily the best method of providing support, according to new guidance. For example, a pop-up alert can only fire after an event has occurred (e.g., a provider has ordered a contraindicated medication). Given that pop-up alerts are not always effective for improving outcomes, CMS encourages the use of CDS interventions that are not pop-up oriented.
Although the trigger intervention certification criteria require EHR technology to produce an alert at relevant points during patient care, the meaningful use objectives give providers flexibility in the types of CDS interventions they employ, and do not limit them to pop-up alert interventions, states CMS in the guidance on CDS interventions. Providers can meet the objectives by using other kinds of CDS, including, but not limited to: clinical guidelines, condition-specific order sets, focused patient data reports and summaries, documentation templates, diagnostic support, and contextually relevant reference information.
The key, CMS asserts, is that the information be presented when relevant, to those who can act on the information, and in a way that supports completion of the right action.
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