Clinical decision support programs can be risky business

From Clinfowiki
Jump to: navigation, search

Clinical Decision Support Programs Can be Risky Business Sharon R. Klein, Esq. and John W. Jones Journal of Healthcare Information Management- Vol 21, No.2 pg15

Questions

  • Does the decision support program increase the liability of the practitioner and the organization if a bad outcome occurs after overriding an alert from the clinical support system?
  • Is there a violation of HIPAA if a vendor for decision support is not hospital based and the web is used as the portal of communication?

Study

  • Opinion of two members of a very large and powerful nationally renowned legal corporation
  • Not based on data or study methodology.
  • This could be a good study idea for claims associated with deviation from standard decision support recommendations. As this study has not quoted a single data element, there is a huge study opportunity here.

Conclusion of the article

To set up policies to document and clarify the reason for deviation from decision support alerts. Vendor support contract to include an item regarding regular updates to keep knowledge base current with community/regional practice standards

Commentary

“The use of computer-based decision support programs in medicine will result in litigation when adverse health care outcomes affect patients”1

Decision support is the buzzword today when we talk of information systems. It promises to reduce medical errors, improve patient outcomes and reduce cost to deliver high quality care. To achieve this goal we have a long way to go. Our systems need to be built with standardized vocabularies, ensure interoperability and provide a knowledge base that is relevant and up to date. Deviation from an alert that is considered standard of care, which leads to an unfavorable outcome, indicates liability. This represents a breach of standard in practice that is set by the medical community. Therefore guidelines and procedures to document an alert should be clearly written in hospital policies.

The other concern is possible HIPAA violation, when clinicians use a web-based portal from an outside vendor for clinical decision support. Many clinical decision support systems will fall within the HIPPA’s healthcare exception, as these are a part of improving health, coordinating care and reducing healthcare costs. The utilization of the outside vendor for decision support needs to be approved by hospital legal team and clearly mentioned as a written hospital policy.

Last, but not the least, the vendor selected for decision support indicate clearly in their contract that the knowledge base will be updated regularly and will meet community/regional standards.

Refrences

  1. Legal issues related to medical decision support R.A. Mller, Journal of clinical monitoring and computing Volume 6, number2/ April 1989
  2. http://www.ncbi.nlm.nih.gov/pubmed/17583163MB