Buy-in by the government for clinical decision support systems is locked in as the CMS pushes for CDS integration with EHRs by way of financial incentives. Such tools aspire to ease the burden on fatigued professionals, but reception is met with mixed reviews. What good are CDS integrations if tools are underutilized or even avoided?
The influential role of the “champion”
Leadership is crucial to staff buy-in. Physician champions can combat burnout by helping restore confidence in CDS capabilities. Such leaders are fluent in CDS best practices and have a knack for coaching fellow team members through trouble areas.
Champions also can advocate for fellow team members as to what CDS improvements and integrations are desired so that the interface adapts to the needs of the practice. Seeing that feedback is not falling on deaf ears will surely encourage buy-in. Here are some tips on how to support CDS engagement and buy-in.
Be reminded of the benefits
Asking why is hard-wired into the medically trained mind. Walking medical professionals through the features and explaining how each of them are of help can reengage clinician users. With CDS tools, clinicians and staff can:
- Increase efficiency and optimize workflows
- Fully disseminate the most current information to the entire team
- Enhance care quality
- Boost patient satisfaction
- Be informed of social and economic risk indicators and recognize patient lifestyle factors
- Promote adherence to guideline-based care
- Have patient education material automatically generated
- Avoid redundant testing
- Cut costs or weigh care options by cost-effectiveness
- Make clinical decisions based on the most relevant evidence-based information
- Choose treatments based on severity index for different diseases
- Avoid major mistakes such as misdiagnoses, medication interactions or incorrect dosage
- Make accurate calculations quickly for drug dosing
- Have helpful alerts, reminders, order sets and templates
- Be informed of drug supply chain information, drug alternatives, and guidelines for drug formulations
- Prevent fraud
- Ensure regulatory compliance while averting CMS penalties
Shadow select users and gather feedback
The best way to find out why teams are not benefiting from CDS tools is to gather feedback. Consider shadowing fellow clinicians and staff as they use the system so you can fully view the user experience from their perspective. This will provide insight and reveal improvement opportunities.
For example, some may complain about doing the same thing twice – once for the EHR and then again so the CDS registers it as completed. Or you may observe that staff are not using medication calculation tools correctly nor at all.
Have a transparent auditing process
Clinicians are more likely to trust CDS tools when they can be confident about the data sources. To assure them that CDS recommendations are based on good data, share who reviews the data and when. Conduct quality checks for accuracy and report your findings back to your colleagues. The data must be updated timely, accurately interpreted, and properly synthesized to be most valuable.
Respect clinician autonomy
To combat reluctance, the CDS should be used to assist clinicians and not be used to micromanage or critique them. Advocate for fellow providers to be approached in a way that is respectful toward their competency and assured that interference from CDS serves a worthy purpose.
Address “alert fatigue”
When it comes to CDS integrations within the EHR, alert fatigue is increasingly common. Too many alerts cause the user to tune out the important ones, while too few alerts defeat the purpose of the CDS. The goal is to minimize and intelligently prioritize alerts. Work with technology teams to configure alerts to work on the front-end (alert when should) and back-end (automatically satisfied when proper measures are taken).
While some would prefer to have alerts off to the side and not obstruct important interface elements, some may worry they will miss critical alerts if they aren’t front-and-center. So, in this case, the best way to configure alerts is in the eye of the beholder.
Streamline the interface and workflow
Some bothersome CDS quirks can be resolved with improved integration. As mentioned before, some CDS users complain that they must do a task more than once – first for the EHR and then again for the CDS.
Seamless integration of CDS into the EHR interface can also reduce the need for tutorials and avoid bombardment of update announcements. New steps intuitively integrated into the workflow or done automatically means the user won’t have to stop tasks until they figure it out – the interface will be streamlined for ease of use.
Customize where possible
CDS is supposed to make your life easier, and customization helps to reach this goal. Personalization for each team role ensures you aren’t seeing those taxing, excessive alerts. Work with the appropriate stakeholders on how to best leverage customization capabilities.
Leverage “wins” to build confidence in CDS
Buy-in relies on the assurance that the CDS provides real value and meaningful improvements for the work being done. The best way to reassure fellow team members of this is to instill and reinforce confidence in CDS. One way to do this is to highlight the “wins” gained along the way. Highlight small successes and progress that demonstrate the effectiveness of the tools.
Champions play a crucial role for the buy-in needed to reap the benefits of CDS integrations. CDS systems have not yet been perfected, but a concerted effort can still be made to calibrate CDS integration so that team members are empowered to do their best work.
CHAD ANGUILM is Vice President of Growth at Medical Advantage, which is a national healthcare consulting firm serving independent practices, practice groups, Managed Services Organizations (MSOs), and health plans and is a subsidiary of the TDC Group, the nation’s largest physician-owned malpractice insurer. For more information on electronic health records, visit the company’s website at https://www.medicaladvantage.com/solutions/ehr-consulting/e-book/, or contact Chad Anguilm directly at [email protected].
