The other key point Blumenthal stressed was that the two most frequently used words:  “meaningful use”….is “not about a technology project” . . . but more of a “change management project”.  Last week in Chicago, the CPMRC International Consortium Summit dedicated a whole day to Foundations in Polarity Management™ in which groups uncovered the dilemmas we must manage as healthcare leaders in regards to technology innovations & practice innovations, framework-driven change & project/initiative driven change, individual & integrated competency, etc.  To achieve Meaningful Use we must see the whole and parts with their dynamic tensions as we move to true transformation to achieve a higher purpose.  The CPMRC learning healthcare community also worked together on leading the implementation science of healthcare transformation and advancement of interdisciplinary integration.  Collaborating and learning together are key to success and sustainability.  There are many collaborative groups here at AMIA as well such as NIWG and TIGER…with a commitment to stretch our thinking and actions in the new world.  These are opportunities of new dimensions and if we “focus on the end-product” it will be a fun, hard, challenging and rewarding ride.

Stay tuned . . .

At a recent workshop (http://healthit.hhs.gov/cds) held at the Health and Human Services headquarters in Washington, Paul Tang, director of the committee that formulates proposals on meaningful use for the Office of the National Coordinator, pointed out that the use of CDS is both explicit and implied in many of the meaningful use recommendations.  According to the meeting summary of Dr. Tang’s remarks, “without CDS, measures of health priorities as defined by meaningful use are less likely to meet quality targets or improve over time.”

 I’m extremely pleased to see this great opportunity for CDS to affect care and health outcomes for the better, for a much larger segment of the population.  But that also means it’s time to take a 2009 look at a question we all think we knew the answer to years ago – what is CDS?  More specifically, do we need to rethink what we know about CDS, if we really want to turn all of this increased technology into better results?  CDS has been very successful in improving quality measures and reducing errors in many institutions, but not all.  What CDS will make the greatest positive difference in the greatest number of practices?

For many, CDS equals alerts – most commonly, alerts about drug allergies and interactions, but also alerts about a variety of potential hazards and opportunities.  Yet, alerting is one of the most intrusive forms of CDS, and not always one of the most useful.  In a recent editorial in Pediatrics (http://www.pediatrics.org/cgi/content/full/124/1/375 ) Dean Sittig of Memorial-Hermann Health (and three others, including me – but the major credit has to be given to Dean) pointed out a number of circumstances under which alerts would likely be ineffective and/or poorly accepted, “compared to other intervention types such as facesheet displays, order sets, patient education handouts, and end-of-visit forms.”  Depending on the clinical objective and where you are in the workflow of care, different CDS intervention types might fit the job best, including intelligent data displays, guideline helpers, context-sensitive reference information, smart documentation forms, procedure guides, performance dashboards, and more.

Given all of this, I have had to broaden the definition of CDS that I use when lecturing, to “provision of information to the healthcare professional, patient or family, filtered for the current situation and presented for greatest impact on the task at hand.”  The ideal CDS intervention helps you get through your current task, answer your current question or need, as correctly and efficiently as possible.  In many cases, the best CDS is something nontraditional – perhaps a video on your iPhone to refresh your memory about that procedure you’re about to do, or a predictive report of your hospitalized patient’s risk of falling. The best CDS is often  something that would not have immediately come to mind if someone asked “what is CDS”?

The past several months have been energizing as healthcare organizations and companies get clear on the promise of improving (dare I say “transforming”?) the US healthcare system with health information technology (HIT) via ARRA funding for meeting “Meaningful Use” criteria.  Here at Elsevier I have the privilege of leading and collaborating with a team of experts on clinical decision support (CDS) who are committed to supporting our customers and HIT vendor partners with value-added products and services to successfully achieve “meaningful use” of their HIT investments.

What do you see when you study the most recently approved HIT Policy Committee’s recommendations for “Meaningful Use” (Meaningful Use Matrix)?

The most logical way to approach this for meeting the ultimate goal as well as achieve funding across the spectrum is to follow that old Stephen Covey leadership principle…. “Begin with the end in mind”.

The end is all about Clinical Outcomes, Efficient Care, Safe Care, Patient/Family Engagement, Clinical Summaries, Care Coordination, Population Management, and Surveillance Measures.

These outcomes call for the marriage of HIT and advanced CDS supporting evidence-based practice as key enablers for every healthcare profession to utilize in their daily practices at the point of care.  They call us to think critically and in new ways about the goals and measurements of each meaningful use criteria to achieve the end in mind!

Stay tuned for deeper exploration of key considerations and successful steps meeting the latest HIT Policy and Standards Committees efforts to achieve true “Meaningful Use”.