Interest in Clinical Decision Support Lacking

If you spend your Saturday afternoons watching home remodeling shows or cooking shows, you realize that having the right tools for the job makes all the difference. What you struggle with in your garage or kitchen the experts make look easy because they have the saw or decorating tip specifically designed for the task at hand.  

Like carpenters and bakers, doctors have access to the right tools for the job. But a new study suggests that many doctors don’t use them. They’re not buying, installing or turning on clinical decision support tools that could make all the difference to their patients.

Researchers from the Rand Corp. and Penn State, funded by a grant from the Agency for Healthcare Research and Quality, looked at the use of CDS tools by health system-affiliated ambulatory-care clinics. They published their findings in the American Journal of Accountable Care. 

Why look at the use of CDS tools by doctors, hospitals and health systems? 

“As the complexity of medical practice continues to increase, CDS tools will provide important support to providers to achieve high performance and succeed under payment arrangements that hold them accountable for cost and quality,” the researchers said.

In short, CDS technologies are the right tools for the task at hand, and that task is driving more value for patients. 

The researchers studied the use of seven CDS functions over a three-year period (2014-2016) by 19,209 ambulatory care clinics affiliated with about 1,600 to 1,700 health systems, depending on the year. The seven CDS functions were:

1. Basic medication screening
2. Clinical guidelines or protocols
3. Community-based EHR incorporated into rules engine
4. Genomics profiling used in orders
5. Preventive medicine
6. Diagnostic result alerts
7. Remote device alerts

What did the researchers find? Well, the good news is that the use of each of the seven CDS functions increased each year at the clinics over the study period. The bad news is that use of each of the seven CDS functions was still relatively low by 2016.

The most-used function was the basic medication screening, utilized by 61 percent of the clinics. The least-used function was genomic profiling, utilized by just 9 percent of the clinics. Put another way, 39 percent of the patients who could have had a basic medication screening didn’t. And 91 percent of the patients who could have gotten their genetic makeup profiled didn’t.

The researchers concluded: “Despite federal investment to promote health information technology adoption, substantial gaps remain in the use of CDS among ambulatory clinics.”

The researchers pondered a number of possible reasons for the variations in the use of CDS functions: meaningful use incentives targeted some functions, not others; ease of implementation; availability of best practices; extent of workflow disruptions; and perceived clinical or financial benefit by clinicians.

“Greater incentives to use CDS to improve care or lower costs, improving availability and usability of CDS capabilities within EHRs, and spreading best practices may help accelerate increased use of CDS in health systems,” the researchers said.

This is one of the big problems with healthcare. It thinks it’s different from other businesses, but it’s not. 

A carpenter will use the right saw to make the best possible table so people will buy it. A baker will use the right decorating tip to make the best looking cake so people will eat it. Doctors, hospitals and health systems should use the right CDS tools to get the best possible clinical and financial results so patients will use them for their care. 

But many physicians, hospitals and health systems don’t. They don’t, the researchers hinted, because there’s no incentive to do so.  

That’s why the move to value-based reimbursement schemes featuring two-sided risk is so critical. Until providers’ economic survival depends on producing the best outcomes for the lowest costs, there’s no reason for them to use the best available tools.  

Thanks for reading.