cadio vascular
Implementing Clinical Decision Support Systems
Download the strategy pdf icon[PDF - 660 KB].
Clinical decision support systems (CDSS) are computer-based programs that analyze data within EHRs to provide prompts and reminders to assist health care providers in implementing evidence-based clinical guidelines at the point of care. Applied to cardiovascular disease (CVD) prevention, this Domain 3 strategy can be used to facilitate care in various ways—for example, by reminding providers to screen for CVD risk factors, flagging cases of hypertension or hyperlipidemia, providing information on treatment protocols, prompting questions on medication adherence, and providing tailored recommendations for health behavior changes.
· Implementation Considerations
The evidence base demonstrating the effectiveness of CDSS is very strong. Research studies that examined CDSS had strong internal and external validity, the Community Preventive Services Task Force concluded that CDSS is effective, and CDSS trials have been replicated with positive results. Implementation guidance on CDSS is available from several sources.
CDSS at South Omaha Medical Associates
South Omaha Medical Associates (SOMA) is a family-owned, family-operated clinic that is centrally located in South Omaha, Nebraska. It has a higher percentage of low-income patients than clinics in surrounding areas. SOMA collaborated with the Nebraska Department of Health and Human Services, Douglas County Health Department, and Wide River Health Information Technology to assess its technology needs and make plans to implement CDSS. As a result of this assessment, the clinic increased its use of EHRs and implemented systems to better identify patients with undiagnosed hypertension, increase use and monitoring of clinical quality measures, and increase use of clinically supported self-measured blood pressure monitoring. These changes improved workflow at the clinic and led to a 25% increase in patient visits since the start of the collaboration. In addition, Blue Cross Blue Shield awarded SOMA its Blue Distinction Award for meeting overall quality measures for patient safety and outcomes.
For more information: Chronic Disease Prevention and Control Program Nebraska Department of Health and Human Services 301 Centennial Mall South Lincoln, NE 68509 Email: DHHS.CDPCProgram@nebraska.gov
References
1. Community Preventive Services Task Force. The Guide to Community Preventive Services. Cardiovascular Disease: Clinical Decision-Support Systems (CDSS). https://www.thecommunityguide.org/findings/cardiovascular-disease-clinical-decision-support-systems-cdssexternal icon . Accessed August 17, 2017.
2. Njie GJ, Proia KK, Thota AB, et al. Clinical decision support systems and prevention: a Community Guide cardiovascular disease systematic review. Am J Prev Med. 2015;49(5): 784–795.
3. NORC at the University of Chicago. Understanding the Impact of Health IT in Underserved Communities and Those with Health Disparities. https://www.healthit.gov/sites/default/files/pdf/hit-underserved-communities-health-disparities.pdf pdf icon[PDF-929 KB]external icon . Accessed February 9, 2017.
4. Mitchell J, Probst J, Brock-Martin A, Bennett K, Glover S, Hardin J. Association between clinical decision support system use and rural quality disparities in the treatment of pneumonia. J Rural Health. 2014;30(2):186–195.
5. Jacob V, Thota AB, Chattopadhyay SK, et al. Cost and economic benefit of clinical decision support systems for cardiovascular disease prevention: a Community Guide systematic review. J Am Med Inform Assoc. 2017;24(3): 669–676.
6. American Medical Group Foundation. Measure Up Pressure Down: Provider Toolkit to Improve Hypertension Control. Alexandria, VA: American Medical Group Foundation; 2013.
7. Optimizing Strategies for Clinical Decision Support. https://www.healthit.gov/sites/default/files/page/2018-04/Optimizing_Strategies_508.pdf pdf icon[PDF – 1.4 MB]external icon . Accessed June 24, 2020
8. Kilsdonk E, Peute LW, Jaspers MWM. Factors influencing implementation success of guideline-based clinical decision support systems: A systematic review and gaps analysis. International Journal of Medical Informatics. 2017;98:56-64.
9. Centers for Disease Control and Prevention. Hypertension Control Change Package for Clinicians. Atlanta, GA: Centers for Disease Control and Prevention, U.S. Dept. of Health and Human Services; 2015.
10. gov. Policymaking, Regulation, & Strategy. Clinical Decision Support (CDS). https://www.healthit.gov/policy-researchers-implementers/clinical-decision-support-cdsexternal icon . Accessed April 12, 2017.
11. Merit-Based Incentive Payment System: Advancing Care Information. https://qpp.cms.gov/mips/advancing-care-information. Accessed September 26, 2017.
12. Agency for Healthcare Research and Quality. Health Information Technology. Clinical Decision Support (CDS). https://healthit.ahrq.gov/ahrq-funded-projects/clinical-decision-support-cdsexternal icon . Accessed April 12, 2017.
13. Fox J, Thomson R. Clinical decision support systems: a discussion of quality, safety and legal liability issues. Proc AMIA Symp. 2002:265–269.
14. Norwegian Institute of Public Health. GUIDES checklist: A tool to assist professionals when implementing guidelines with computerized decision support. https://www.guidesproject.org/external icon . Accessed March 22, 2018.
Note: The web version has been updated in an effort to keep the linked resources current, and for this reason some of the content may differ with the PDF version.