Accountable care driven by data
Clinical Decision Support Systems, or CDSS, can inform physicians while improving the rate of preventive services and patient engagement. While some physicians balk at the notion of a machine dictating treatment protocol and health management plans, the primary role of CDSS is informing doctors to make better decisions.
In a 2012 article in Family Practice Management, William McLeod, Robert Eidus, MD, and Elizabeth Stewart explain that when medical providers use CDSS correctly, electronic health records become “sophisticated tool(s) that help you aggregate and synthesize data at the patient and population levels.”
First generation EHRs were cumbersome to navigate, taking up valuable time as physicians searched files to locate prior test dates and results. Stand-alone clinical decision support systems designed to interface with EHR platforms provided more robust knowledge bases and user-friendly report generation, which discouraged clinicians from fully utilizing EHR systems because they didn’t have the time or staff to write their own algorithms or wait on IT to design report generators.
Today’s more sophisticated EHR systems include embedded CDSS that consider not only medical history, but also collative information about active symptoms, lab results and medication; giving doctors a comprehensive snapshot that suggests current treatment plans and indicates unmet needs, such as late mammograms, missed appointments and overdue chronic needs care.
In short, CDSS allows the doctor to address active symptoms and discuss preventive care services at every visit, regardless of the impetus that prompted the appointment, improving health management outcomes for patients and time management for clinical staff.
What does accountable care driven by data look like? For one, healthcare professionals need to be prepared to help patients manage lifestyle goals as well as health challenges. An informed care team is better equipped to provide ancillary resources and counseling specifically for an individual patient based on past medical history and current health status.
Reports generated by CDSS provide valuable insight into what support tools patients need to thrive. Data also defines target outreach areas and obstacles to continuity of care across multiple specialties. For example, Alan Shapiro MD, senior medical director of South Bronx Health Center, explains that with the ability to tailor reports based on HbA1c levels or blood pressure readings, physicians can quickly identify patients that may benefit from more frequent visits or enhanced collaborative efforts among providers.
Both individualized care and population-based reports are examples of off-line population based systems that improve patient outcomes and control costs associated with managing healthcare.
Connecting social determinants with EHR data
Offline CDSS strategies include examining the patient population to look for trends among patients who have similar health challenges like diabetes, high blood pressure, and familial cardiac risks. This enables them to provide solutions so they can better manage chronic conditions and monitor progression with preventive services and community outreach programs to inform and educate patients. Research suggests this improves patient engagement and improves compliance.
It is important to consider social determinants and their effect on health maintenance. Factors such as age, where patients work, neighborhood demographics, lifestyle and social activities, financial circumstances and other environmental aspects significantly impact health status.
Until recently, health administrators didn’t realize the integral role EHRs could play in treating individual patients or the vast amount of information available about population groups and the determinants of health management. CDSS offer researchers and clinicians a unique opportunity to delve deeper into the connections between social determinants and clinical outcomes.