Clinical Decision Support Tools Still Falling Short

A new report about healthcare provider experience with clinical decision support (CDS) tools says the systems are not integrated enough to deliver the strategic direction providers are looking for. The report, issued by KLAS, a company that reviews and rates health care technology vendors, products, and services, says that these CDS systems lack true integration. The report is titled, “Clinical Decision Support 2013: Sizing Up Point-of-Care Reference Tools.”

CDS tools provide clinicians, staff, patients or other individuals with knowledge and person-specific information, intelligently filtered or presented at appropriate times, to enhance health and health care. CDS encompasses a variety of tools to enhance decision-making in the clinical workflow. These tools include computerized alerts and reminders to care providers and patients; clinical guidelines; condition-specific order sets; focused patient data reports and summaries; documentation templates; diagnostic support, and contextually relevant reference information, among other tools.

Health information technologies designed to improve clinical decision-making are particularly attractive for their ability to address the growing information overload that clinicians face, and to provide a platform for integrating evidence-based knowledge into care delivery. The majority of CDS applications operate as components of comprehensive EHR systems, although stand-alone CDS systems are also used.

“Providers acknowledged the impact the tools are having and the efforts some vendors are making to leverage strategic partnerships but declared that most products offered are still too much in silos,” said report author Adam Cherrington. “Providers were very quick to mention the efforts of EBSCO, Elsevier, Wolters Kluwer, Truven Health Analytics and others to align with their needs, but even though providers appreciated the high performance of most solutions, they felt that more portfolio integration would result in even greater impacts on patient care.”

The report focused on four groups of CDS tools: disease reference, drug reference, nursing reference and diagnostic decision support. As part of the report, KLAS interviewed providers about the impact of these tools on patient care, usability, perceived value and workflow.

The new report mirrors the evidence in a literature review published in the Journal of Informatics in Health and Biomedicine that investigated CDS in the use of genetically guided personalized medicine (GPM).

In that review, Brandon M. Welch and Kensaku Kawamoto, both in the department of Biomedical Informatics and Program in Personalized Health Care at the University of Utah, screened 3416 articles, of which 38 were primary research articles. Their research included family history-driven CDS, cancer management, and pharmacogenomics. Nine randomized controlled trials of CDS interventions for GPM were identified, seven of which reported positive results.

They concluded that additional research and development is needed for identifying how best to leverage CDS to bridge the gap between the promise and realization of GPM.