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.

 

Aging services technologies were front and center this month when the acclaimed TED Talks featured presentations by CAST Senior Fellow in Technology Innovations Eric Dishman and LeadingAge Chair Audrey Weiner. TED is a nonprofit organization that disseminates “Ideas Worth Spreading.”

Dishman shared the details of his recent kidney transplant -- including an ultrasound image of his new kidney—during a March presentation. He then outlined what his experience taught him about the health care system.

Weiner, the president and CEO of Jewish Home Lifecare, a CAST Patron in New York, will discuss her organization's technology partnership with Panasonic during TEDMED later today (April 18). We hope you can attend Audrey’s presentation online.

TEDMED is an annual program featuring short talks from thought leaders in health and medicine. The event celebrates the power of unexpected connections to create important new possibilities.

Proceeding of CAST Commission Meeting

We’re pleased to present an in-depth summary of the CAST Commissioners’ March meeting. That summary is included in a new CAST report called What Matters Most to LTPAC? How Payment Reforms, Data and Education Will Transform Business Models for Long-Term and Post-Acute Care Providers.

I hope you’ll take a look at the report, which summarizes:

  • A conversation about payment reforms with Dr. Mark McClellan, CAST Chair.
  • A presentation on Population Health Management by Dr. Charles Lagor of Philips Home Monitoring.
  • A discussion about our plans for a new CAST-sponsored education initiative focusing on aging services technologies. 

Exploring Therapy and Rehabilitation Technologies

Be sure to check out the 4th installment of our 12-part series on technologies featured in CAST's new video, called High-Tech Aging: Improving Lives Today. This month’s installment addresses therapy and rehabilitation technologies and their role in accelerating recovery and reducing mobility impairments and physical decline.

CAST Case Study

We continue to highlight one case study each month from our Preparing for the Future case study collection. This month's case study is about Mather LifeWays, a LeadingAge member in Evanston, IL. I hope you will read this case study and integrate some of its lessons into your own planning.

This Month’s Issue of Tech Time

I hope you enjoy this issue of Tech Time! I urge you to read about the great things that CAST Supporters and Business Associates are doing in their own communities and markets. Read about how Morningside House Long Term Home Health Care Program, a LeadingAge member in New York, is using remote monitoring technology to reduce expensive hospital visits among its clients.

In addition, HealthMEDX, a CAST Supporter in Ozark, MO; It’s Never 2 Late, a CAST Supporter in Centennial, CO; Selfhelp Community Services, a CAST Patron in New York; and The Oaks, a LeadingAge member in Orangeburg, SC, have good news to share with fellow CAST and LeadingAge members.

Finally, I hope you will join us for the annual Long-Term and Post-Acute Care Health Information Technology Summit. The Summit takes place June 17-18 in Baltimore, MD. It’s a must-attend event if you are wondering how your organization can meet the needs of an aging population while aligning your initiatives with the national health care and health information technology strategies.

As always, please contact me with any comments or questions.

 

EMR has helped MJHS's home care agencies be more efficient with aggregated data to improve internal operations while the ability to provide custom­ized data about outcomes to partners and payers a key success factor in a future environment that will most certainly include payment bundling, capitation, health homes and Accountable Care Organizations (ACO).

MJHS Case Study 

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