As healthcare facilities transition to electronic medical records (EMR), almost every recordkeeping system will include some form of clinical decision support software (DSS). These software programs are designed to help physicians and other healthcare workers with decision-making tasks regarding patients’ diagnoses and treatments. Because the software can work in concert with the larger EMR system, it can access all kinds of pertinent information such as patients’ health history, current medications and allergies to help health professionals make effective decisions.
“Decision support software really improves clinical practice because it improves efficiency,” says Joseph Garbarino, PharmD, clinical pharmacy informatics specialist at Mercy Health System in Conshohocken, Pa. “All the information that could inform your decision is available at your fingertips.”
DSS in Action
Recently, a doctor tried to prescribe amiodarone for a patient at Mercy Health System. The patient, who is allergic to iodine, had experienced a negative allergic reaction to the drug before, and when the doctor entered the prescription, the iodine allergy was noted, along with the history of reaction to the drug. “You normally wouldn’t think about an iodine allergy being a problem with that drug, but it did cause a problem for that patient,” Garbarino says. “When the software flags a medication or a patient, it tells you why it’s being flagged and exactly where the interaction is. In this case, the flag from the software prevented that patient from having another bad reaction.”
At Mercy Health System, DSS has “prevented a lot of near-misses,” Garbarino says. “There are tons of case studies showing how the software definitely makes a difference in patient care. When used correctly, DSS can help the clinician reach best practice standards for patient safety.”
Implementing a DSS Program
To start improving patient care through the use of decision support software, begin by analyzing the system your EMR vendor provides out of the box, Garbarino says. “Clinical decision support is often built into an EMR vendor’s program, but it may not be too robust,” he says.
While almost all decision support software programs include allergy checking, many also include various other features, such as displaying information about how drugs interact with other drugs, clinical drug content and patient discharge information. Some programs provide links to literature that supports their recommendations, or produce reports that recommend cultures or renal dosing.
Patience Is Key
Launching a DSS program takes a considerable amount of time and training, according to Stephanie Thompson, PharmD, HealthTrust’s former director of clinical pharmacy services. For the systems to be successful, clinicians have to learn the system, help determine which flags to set, track the alerts, validate the information and update the content. “Is it worth it? Yes,” Thompson says. “But it is often overwhelming for all clinicians involved when a system adopts a DSS tool. Patience is key. Like all technology, these tools are definitely valued more as users become more familiar with their benefits.”
If your basic DSS system imbedded in your EMR solution doesn’t include all the components you’re looking for, consider seeking another system from a separate vendor or an upgraded system from your EMR provider. “First, see what your vendor offers out of the box, and then customize it to meet patient needs at your facilities,” Garbarino advises. “If the system you have doesn’t provide the solution you need, you may need to go to a third party. The next step is to obtain software that will dive deeper than your basic program.”
Regardless of which program you use, each facility can determine what types of information will be displayed to physicians and others through its DSS system. For instance, at Mercy Health System, the pharmacology department has set up its DSS program to provide physicians with research support anytime it flags a choice of medication. “It might say, ‘Consider this drug,’ and include a link. Or it might say, ‘The FDA says in this clinical situation, this drug is the best one to use,’ ” Garbarino says. “You can program the decision support software to do that automatically.”
Mercy Health incorporates a blue ribbon system to show best practices for different situations. The drug that research shows to be the best practice drug in a particular clinical situation will be tagged with a blue ribbon in the system, which helps the facility to achieve the standardization of care that is an important component of healthcare reform.
As with any program that aims to improve patient care and patient outcomes, your DSS system will only be successful if it wins the approval of and participation from the clinicians who must use the system. The main drawback to achieving buy-in from these important stakeholders is “over-flagging,” Garbarino says. “Pharmacists are used to it, but you don’t want to over-flag the physicians. If they are over-flagged, they may ignore an important flag.”
At Mercy Health, the key to achieving physicians’ approval for the program is to avoid making them feel as though they are being told how to practice medicine; instead, they should see the program as a vital tool that can help them keep track of constant changes in government regulations, medical research and patient conditions.
“Be honest with your physicians,” Garbarino advises. “Tell them, ‘We’re flagging this because we want to improve patient safety.’ But encourage them to provide input into the program. Ask them to let your department know if they are getting flags they don’t want to see. You can set the system’s flagging level based on what you want them to see.”
When physicians understand the necessity of using the DSS system and how it can help them perform better, and when they feel that their input is a valued part of the solution, they are more likely to cooperate. And their cooperation is vital to meeting the goals of patient safety and standardization that DSS systems set out to reach.