Enhancing the precision of clinical decision support

Many hospitals and health systems have invested extensive time and resources developing and implementing clinical decision support (CDS) to help improve patient outcomes. As a physician, I believe we achieve the best outcomes when CDS technologies work in-sync and at the speed-of-care delivery to ease clinician cognitive burden and provide timely patient-specific evidence-based guidance at opportune moments within the natural clinical workflow. Doing so fully realizes the potential cost savings of CDS and improvements to patient outcomes.

Five ways to make sure CDS is impactful
Clinical decision support systems are tools designed to enhance patient care and provide clinical knowledge and relevant patient health information at appropriate times. Several factors can be key drivers in engaging physicians and gaining maximum results using CDS.

Provide patient-specific guidance. Evidence based guidelines are created with the aim of helping clinicians make informed decisions based on high quality evidence distilled from randomized trials into best practice guidelines. However, real world scenarios are complicated by patient level factors like multiple comorbidities and unique medications, medical and surgical histories, diet and lifestyle. Highly intelligent CDS applications differentiate by providing patient specific guidance that is individually tailored through streamlining disparate recommendations into a single, cohesive care guidance solution.

Make time of the essence. It’s crucial that CDS technologies provide guidance within an appropriate time window to be able to optimally impact patient outcomes and reduce unwarranted costs. Any delay in the timely identification and treatment will likely lead to poor outcomes down the line. Interventions will be less effective and there will be a higher risk of longer length of stay and additional costs of care.

Reduce alarm fatigue. Alarm fatigue is often the main clinician complaint when using a CDS system. The main reason is many systems have been designed to cast a wide net to cover all potential interventions. However, this wide-net approach can result in false positive alerts that can over-burden the care team. A truly smart CDS system alleviates false positive alerts using rules and algorithms to curate highly accurate surveillance that doesn’t miss patients with a disease (high sensitivity), while minimizing the false positives in patients that don’t have a disease (high specificity).

Minimal Interruptions. Using minimally interruptive CDS is critically important to maximizing clinical efficiency and reducing physician burnout. Ideally, CDS recommendations should integrate seamlessly into a clinician’s electronic health record (EHR) workflow, reduce their cognitive burden, negate duplicate documentation, minimize their number of clicks, and only surface recommendations at opportune moments within a clinician’s workflow.

Deploy through the cloud. Another limiting feature of many CDS systems is in their deployment model. To be most effective, CDS should be easy to curate and maintain, be sharable and reusable for different diseases, and available for deployment across care settings and institutions within a health care organization to truly standardize the quality of care. A cloud-based CDS solution can also be instrumental in tracking a patient’s progress throughout the care continuum.

The clinical science is good; clinical technology can make it better
Implementing effective clinical decision support can be a complex challenge, but when the focus is on delivering smart, timely, and easy to consume patient-specific guidance, the results can be significantly rewarding. At Optum, we strive to combine clinical decision support best practices with the latest in advanced analytics, clinical expertise, and technologies that are deeply integrated and embedded within the clinician workflow.

Our patient-specific care pathways are driven by intelligent cloud-based logic to create a seamless EHR-integrated experience for multidisciplinary care teams and improved outcomes for their patients. These technologies will continue to be an important part of the work we do here at Optum for me, as a medical professional, for my physician colleagues, and for our patient communities.

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About the author

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Sharad Manaktala, MD, MPH, PhD
Vice President (Care Pathways), Provider Technology Services, Optum Advisory Services

Sharad Manaktala is a physician informatics leader within Optum Advisory Services. Sharad has over 16 years of healthcare experience in clinical informatics, research and analytics, and has led the development of several decision support technologies to reduce variation in care and improve and patient outcomes.



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