Implementation Pearls from a New Guidebook on Improving Medication Use and Outcomes with Clinical Decision Support
Studies reveal that applying CDS to medication-related challenges has shown successful results. Despite these successes, studies also have shown that even with advanced clinical systems and CDS, Adverse drug event can persist. To help ensure that CDS is successfully deployed many diverse organizational and individual stakeholders came together to synthesize CDS implementation best practices. A central premise of the recommended implementation approach is that successfully applying CDS to address targeted objectives requires that the CDS five rights must be addressed. The CDS intervention must deliver the right information, to the right person, in the right format, through the right channel, at the right point in workflow.
THE CDS FIVE RIGHTS OVERVIEW
- Right information – components include pertinent to clinician and patient at hand, Address specific information need or action at hand, Current, believable and trusted by recipient, Contain the appropriate level of detail.
- Right person- The healthcare team is comprised of several key players such as physicians, nurses, pharmacists and others—each of which play different patient care roles, and has different decision support needs and opportunities. Identifying the connection between the right information and the right person is the basis of the second CDS right.
- Right CDS intervention format- it is important to consider the full portfolio of CDS intervention types in addressing specific CDS objective; such as an alert, order set or reference information to answer a clinical question.
- Right channel- the communication channel through which the right information will hopefully be conveyed to the right person in the right format. For example, a clinical information system such as an electronic medical record, personal health record or a more general channel such as the internet or a mobile device.
- Right point in the workflow- understanding of the workflow that a planned CDS intervention is designed to support is essential for intervention success. For example, at time of decision, action, need.
OTHER PEARLS FOR SUCCESSFUL CDS PROGRAMS
Overview of selected best practices for setting up a successful CDS program to address medication use, and other priority targets.
- Establish a solid foundation for CDS efforts- Creating a shared understanding of basic concepts and approaches and of improvement and intervention opportunities and strategies. Another key foundation component is quantifying baseline performance levels around the targets to be addressed with CDS and producing some commitment to targeted benefits.
- Deploy CDS for maximum acceptance-
When end-users are involved in developing CDS interventions that become tools that can help them achieve their important goals (or are at least aligned in some way with them), the resulting interventions will be much more likely to be used and useful.
- Devote adequate attention and resources to measurement-
Many CDS programs do not devote adequate attention to measuring intervention effects—both intended and unintended – and thereby miss important improvement opportunities. Issues to track for CDS interventions include structural measures, processes and outcome measures.
- Manage knowledge asset and decisions proactively-
As an organization’s CDS program evolves over time, there is an increasing volume of knowledge assets such as order sets, rules, referential content, as well as decisions related to those assets, which are essential to proactively manage.
The CDS five rights approach provides a framework for successfully linking CDS intervention features with specific objectives the interventions are intended to address. This also includes establishing a foundation for CDS, deploying CDS for maximum acceptance, measuring CDS effects and proactively managing CDS knowledge assets and decisions.
- Implementation Pearls from a New Guidebook on Improving Medication Use and Outcomes with Clinical Decision Support. Effective CDS is Essential for Addressing Healthcare Performance Improvement Imperatives. Sirajuddin AM1, Osheroff JA, Sittig DF, Chuo J, Velasco F, Collins DA. J Healthc Inf Manag. 2009 Fall;23(4):38-45. http://www.ncbi.nlm.nih.gov/pubmed/?term=Implementation+Pearls+from+a+New+Guidebook+on+Improving+Medication+Use+and+Outcomes+with+Clinical+Decision+Support%3A