Value of Clinical Decision Support Systems in Home Health & Hospice

Clinical decision support systems provide clinicians with logically filtered, evidence-based data combined with patient-specific data to enhance clinical decision-making at the point of care.

Found in leading EHR software systems, clinical decisions support systems include:

• Alerts
• Warnings
• Documentation templates
• Clinical guidelines
• Contextually relevant information
• Condition-specific order sets

How do clinical decision support systems work?

The main purpose of clinical decision support is to provide timely, relevant information to clinicians in a manner that supports accurate clinical decision-making. These tools are designed to help quickly comb through vast amounts of evidence-based clinical information to suggest problems, goals, and interventions, notify clinicians of information they may not have seen or been aware of, or to catch potential problems.

The Five “Rights” of Clinical Decision Support Systems

There are five “rights” that make up the best practice framework of clinical decision support systems. This concept says that for them to be effective they must provide:

• The right information
  • This information should be evidence-based, derived from a set of recognized guidelines or national measures.
• To the right people
  • The right people may include nursing staff, therapists, or aides. They should be presented with information pertinent to their roles on the care team.
• Through the right channel
  • Clinical decision support is typically delivered through an EHR. This allows the information to be relayed quickly, enabling prompt action to be taken.
• In the right intervention formats (guided workflow, alerts)
  • As noted above, clinical decision support tools can include alerts, documentation templates, and guided clinical workflows. It is important that intervention formats accurately reflect the action that should be taken. Sometimes an alert will suffice, while other times a complete guided workflow is necessary.
• At the right points in the workflow
  • Information presented to a clinician at the right time can have a positive impact on patient outcomes.

Why are clinical decision support systems valuable to decision-making?

Clinical decision support systems are not intended to replace clinical judgment. Instead, they provide clinicians with pertinent information to enable them to make timely, well-informed, high-quality decisions.

Benefits include:

• Improved patient outcomes
• Increased efficiency
• Improved care quality
• Reduced risk of errors
• Reduced costs

When clinical decision support systems are integrated into the system, EHR use improves significantly as information is made available in real-time, at the point of care. Organizations become more efficient and effective at delivering the right care at the right time.

How can home health and hospice agencies benefit from clinical decision support systems?

Clinical decision support is the centerpiece of the Medicare EHR Incentive Program. While these programs are not currently relevant to home health and hospice care, it is likely only a matter of time before our industry is required to implement clinical decision support interventions.

As reimbursement levels decline and transparency into care quality increases, it is important that the care that is provided, and the documentation that backs that care up, is accurate and clinically appropriate. Clinical decision support tools ensure that agencies provide the highest quality patient-centered care, without sacrificing efficiency or patient/caregiver satisfaction. Care is better coordinated, performance is better, and costs are controlled.

Take for example Susie Nurse. She is visiting Bill, a home health care patient. As Susie goes through her assessment, she indicates in her EHR that Bill has diabetes. The clinical decision support tool in Susie’s EHR then pulls up a number of evidence-based problems, goals, and interventions for Bill based on her telling the system that he has diabetes. Susie is then easily able to identify the goals and interventions that she feels are appropriate for Bill based on her judgment. Susie is able to record these goals and interventions quickly and easily, right in Bill’s home. Should a new problem be identified, the tool would then suggest new goals and interventions, constantly updating Bill’s care plan.

Clinical decision support systems integrate patient information with evidence-based data, and present them to the clinician in a meaningful way, allowing the clinician to take immediate action. This enables the clinician to direct her attention to the patient rather than searching through medical records, the internet, handbooks, or other sources of information for additional information.

HEALTHCAREfirst’s Clinical Decision Support Systems

HEALTHCAREfirst’s home health software and hospice software have a number of clinical decision support systems designed to improve the clinical decision-making process. Alerts, documentation templates, warnings, and scrubbing tools are all included in our software for no additional charge. In addition, our systems include enhanced clinical decision support technology – CAREpliance.

CAREpliance is thoughtfully designed clinical workflow that follows standard patient care processes, equipping clinicians with the most thorough, evidence-based guidance available to reinforce sound decisions at the point of care. When problems are identified, the system suggests goals and interventions, allowing the clinician to customize the care plan and build a story for the patient. The result is comprehensive care with the very best possible outcomes, and consistent clinical documentation that ensures compliance, minimizing risks of audits, denials, and takebacks.