The highest-performing CDS platforms actually issue alerts infrequently, remaining silent until the system determines the likelihood of a potential error or adverse effect. The purpose of CDS is to support a clinician’s judgment rather than replace it, and to avoid counterproductive false alarms, which may promote alert fatigue. An alert appears only when a CDS recognizes that a clinician has deviated from a local guideline or PowerPlan. The clinician then has the option of following or ignoring the alert. In either case, the CDS system will record the clinician’s subsequent decision so medical leadership can take appropriate action—such as correcting clinical behavior or having the prompts fine-tuned for accuracy.
Informing care to improve patient safety
A primary purpose of CDS is to improve patient safety with alerts based on analysis of a complete overview of the patient’s clinical condition. These alerts may include:
Information suggesting the need for correction in the course of care. For example, when a patient is admitted for severe headache and lab tests indicate normal platelet values, standard diagnostic procedure may call for a lumbar puncture (LP). If, however, the CDS detects from pharmacy records that the patient is being treated with anticoagulants and is therefore at high risk of bleeding during an LP, it can alert the clinician to this potential. The clinician can then ensure patient safety by addressing any coagulation abnormality prior to proceeding with the LP.
Information indicating an undetected clinical development. Many hospital-acquired conditions are difficult to detect in their early stages, but CDS monitoring can help. Consider sepsis, a leading hospital-acquired cause of death for which time to diagnosis is essential. Intelligent CDS systems can detect very early signs of sepsis, noting when successive lab tests indicate a rising white blood cell count and/or when a patient is in the initial stages of hypotension and fever. By alerting clinical staff to intervene well before the signs of sepsis can be determined by examination, CDS enables intervention at the earliest possible opportunity.
Information to promote safer imaging. Alerting clinicians to unintentionally duplicative imaging studies has long been a fundamental CDS function. Intelligent CDS systems can further reduce unnecessary imaging by evaluating imaging need relative to a patient’s condition. For example, when a patient presents with signs of right lower quadrant abdominal peritoneal irritation, a pediatrician may order an abdominal CT scan for suspected appendicitis. Best-practice guidelines advise performing abdominal sonography prior to a CT scan to lessen radiation exposure and associated malignancy risk. CDS can point out cases in which the abdominal ultrasound was not done, and if not contraindicated, it can alert the clinician to order one—potentially avoiding unnecessary exposure to radiation and lowering the cost of care.
Informing care to reduce hospital readmissions
CDS systems can promote adherence to best-practice medical guidelines and improve both immediate and long-term patient outcomes. CDS systems that issue alerts to outpatient as well as inpatient settings add even more value in care continuity. By promoting post-discharge medication adherence and more consistent follow-up appointments, CDS can help prevent deterioration that may contribute to avoidable readmissions. This is especially valuable for patients with chronic conditions. CDS systems, alerts for patient and family education before discharge, and promotion of risk factor recognition and control have been proven to reduce the readmission rate. Improved performance in the CMS stroke measure, lower stroke recurrence rates, and overall reduction in 30-day readmissions have all been demonstrated in stroke patients whose clinicians received CDS alerts informing them that pre-discharge education had been missed.
Patient safety and reduced readmissions start with sound decisions
Improving patient safety and curbing excessive readmissions depends largely on optimizing the decisions clinicians make every day. Those decisions are driven by information from multiple sources and knowledge gained from years of training; the rapid and accurate analysis of that information is a heavy responsibility.
With intelligent CDS platforms, hospitals and health systems have new capabilities to support clinical decision-making. No skilled clinician expects a technology platform to direct care, and it is highly unlikely that computers will or should make actual care decisions. But the timely provision of information and real-time analysis increasingly makes CDS an indispensable care tool—and an especially effective means of promoting patient safety and reducing hospital readmissions.
Ami Mayo, chairman of medCPU’s medical department, has more than 25 years of clinical experience in surgery and critical care medicine. His medical career has focused on emergency surgery, and management of the most complicated trauma and surgical patients in need of critical care. He has practiced in major Israeli hospitals and been involved in medical research focusing on disaster medicine, critical care in extreme scenarios and surgical education. He is among the first physicians in Israel to implement EMRs in critical care departments and also currently serves in the Israeli Defense Forces as a Surgeon for Special Operations.