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What clinical decision support capabilities will I need to implement?

Clinical decision support systems are interactive functions incorporated into EHRs that assist health professionals make decisions and provide appropriate clinical care.  Clinical decision support utilizes the patient information that the provider has entered into the EHR and existing medical evidence, and then runs through various algorithms to deliver computer-generated recommendations or reminders.  Clinical decision support can provide a broad variety of support, including reminders for overdue treatments, alerts for abnormal values, and assistance with medication prescribing.  It can be especially useful for the management of chronic diseases (e.g., diabetes) that require ongoing patient follow-up and a variety of interventions.

Core Objective for Eligible Professionals and Eligible Hospitals: 

  • Implement one clinical decision support rule relevant to specialty or high clinical priority along with the ability to track compliance with that rule.  

Measure: 

  • One clinical decision support rule is implemented.  

All certified EHRs will be capable of automated, electronic clinical decision support rules (in addition to drug-drug and drug-allergy contraindication checking) based on the data elements included in the problem list, medication list, demographics, and laboratory test results.  In addition, some certified EHR systems allow providers to design their own clinical decision support rules.  Electronic clinical decision support will also automatically and electronically generate and indicate in real-time, notifications and care suggestions based on clinical decision support rules.  As you choose which rule to report, you should determine which clinical decision support rules and notifications are supported by your EHR (only 9 of the 44 measures are required for EHR certification) and which are applicable to your practice.

You may choose the specific rule to implement, so long as it is relevant to your specialty or is a high clinical priority and able to be tracked for compliance.  Any of the 44 clinical quality measures that are being tracked for Meaningful Use would be considered high priority.  A primary care physician, for example, may choose to report on the measure, “Diabetes Mellitus: Hemoglobin A1c Poor Control in Diabetes Mellitus.”  This requires the reporting of the percentage of your patients aged 18 through 75 years with diabetes mellitus who had most recent hemoglobin A1c greater than 9.0 percent.  For a full list, see CMS’ Overview of Clinical Quality Measures.  There is no threshold as to what is acceptable or not acceptable; you are required only to report on this measure.   

Related Resources:

Meaningful Use Final Rule – See Federal Register Table 6, pages 44398-44408, for a complete description of the 44 clinical quality measures and electronic measure specifications.
CMS’ Overview of Clinical Quality Measures – A listing of the three core, three alternate core, and 38 additional clinical quality measures. AHRQ Clinical Decision Support Initiative – This website provides information on AHRQ’s CDS-related research and demonstration projects. It includes links to white papers, podcasts, and implementation guides.
Effects of Computerized Clinical Decision Support Systems on Practitioner Performance and Patient Outcomes. A Systematic Review go to exit disclaimer– Journal of the American Medical Association (JAMA) article by Garg et al. assesses the benefits of clinical decision support systems.
Design and Use of Decision Support in a Primary Care Network go to exit disclaimer– PowerPoint presentation by Joseph Lurio, Chief Medical Information Officer of the Institute for Family Health, describes the underlying principles and use of computerized clinical decision support and how to comply with related EHR Incentive Program criteria.   
Diabetes Management and Meaningful Use go to exit disclaimer– Presentation by Elizabeth Molina-Ortiz of the Institute for Family Health, explains its experience using clinical decision support tools for diabetes management and for meeting the EHR Incentive Program requirements.  

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