Alma's Technology: Clinical Decision Support

Center Post

CAST’s new video, , follows 83-year-old Alma Jones on her journey from home to hospital, to a rehabilitation center, and back home. In this 8th installment of our 12-part series on “Alma’s Technology,” CAST Executive Director Majd Alwan discusses clinical decision support systems.

I wish I could give you Naproxin for your arthritis but I see here they started you on a blood thinner in the hospital. Unfortunately, blood thinners and Naproxin are a dangerous combination. The system red-flagged me when I entered the prescription.

Alma Jones is tired and her arthritis is acting up. She asks her primary care physician, Dr. Lang, to prescribe a drug called Naproxin to ease her pain so she can sleep better at night. Dr. Lang would like to comply with Alma’s request.

Fortunately, an electronic version of Alma’s health record is stored at Dr. Lang’s office. The clinical decision support (CDS) feature built into that electronic health record (EHR) system alerts Dr. Lang that a prescription for Naproxin would not be in Alma’s best interest.

The CDS system tells Dr. Lang something he might not have known otherwise: that the doctor who recently treated Alma in the hospital after she had a stroke prescribed a blood thinner to help her avoid having another stroke. Naproxen also thins the blood. And excessive blood thinning may lead to bleeding.

A simple electronic alert helped Alma avoid a dangerous health setback that could have landed her in the hospital again.

Alma is a fictional 83-year-old great-grandmother and the central character in CAST’s High-Tech Aging video. The video shows how Alma stays healthy and independent after a stroke by staying connected with her health care providers from the comfort of her own home.

I’ll be exploring CDS in this 8th installment of our 12-part series on the technologies that appear in the High-Tech Aging video.

What is Clinical Decision Support?

Clinical decision support (CDS) systems, like the one Dr. Lang uses, give health care providers critical information that can help them determine the best and safest treatment for patients like Alma.

These technologies don't make decisions for a physician. But they do help clinicians sift through, and make sense of, the sometimes overwhelming amount of data included in a patient's EHR. This information helps the clinician make informed treatment decisions that take a variety of factors into account, including the patient’s past medical history and all the medications currently prescribed. When the EHR is interoperable, it might also contain the patient’s recent treatments by other physicians.

CDS encompasses a variety of tools, including computerized alerts and reminders like the one that Dr. Lang received. CDS systems can also offer physicians other types of diagnostic support. These include clinical guidelines, condition-specific order sets and relevant reference information. CDS systems can also provide focused patient data reports and summaries.

A CDS system can be integrated into an EHR, a telehealth and remote patient monitoring solution, or a wound care management system. According to a recent Report to Congress on aging services technologies written by CAST and NORC at the University of Chicago, CDS can help physicians and patients manage:

  • Chronic disease: CDS helps clinicians schedule and remind patients about follow-up visits, lab tests, diet, exercise and medication adherence in accordance with best practice guidelines.
  • Medications: Automated CDS systems have been shown to reduce medication errors by providing clinicians with up-to-date information about patients' health conditions, medications and functional abilities. These systems are particularly useful in helping physicians safely manage and coordinate care for older patients like Alma, who have complex medical conditions and are being treated with multiple medications. 
  • Fall prevention: CDS systems may include information on history of falls and fall risk factors. This can help providers more easily identify older adults who have an elevated risk of falling, and intervene before a fall occurs. 
  • Pressure ulcers: CDS systems can provide a process to document observations related to wound healing/progress. They can then provide recommendations to help clinicians apply best practices to avoid pressure ulcers, prevent skin deterioration or accelerate wound healing. 
  • Inappropriate hospitalizations: CDS systems can provide a process and reminders to record observations and resident status, and provide recommendations to help nursing home staff avoid sending residents on an unnecessary trip to the emergency room or a hospital.

The CDS Imperative

CAST's newly updated EHR case studies on Clinical Decision Support, Interoperability and Health Information Exchange suggests that CDS support is no longer optional for long-term and post-acute care providers. The case studies illustrate that using EHRs with CDS capabilities is essential to:

  • Improving care quality.
  • Driving efficiencies.
  • Reducing hospital readmissions.
  • Strengthening partnerships and strategic positions with other care providers like hospitals, accountable care organizations and physicians.

Selection Tips

As you consider which CDS system to implement, it’s important that you first take time to learn about the range of CDS system available for your care setting. In addition:

  • Identify the clinical issues you face in your organization, including medication management and inappropriate hospitalizations. 
  • Determine which CDS system can help you address those issues.
  • Look for a CDS system that implements geriatric best-practice guidelines; caters to multiple chronic conditions and co-morbidities that are common among older adults; and is easy to use and customize. 

Make sure your clinical staff is engaged in CDS evaluation, demonstration and selection, as well as implementation, customization, testing and ongoing quality improvement initiatives post-implementation.

Finally, if you don’t have an EHR in place and are considering implementing one, make sure to check the updated CAST EHR whitepaper and CAST EHR Selection Matrix, and CAST EHR online Selection Tool for available CDS functionalities. If you already have an EHR, consult with your EHR vendor to see what functionalities the vendor may be able to implement for you.