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Carrie Vaughan, for HealthLeaders Magazine, October 8, 2009
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Decision-support tools are the key to realizing "meaningful use" from EHRs.

Want a healthcare system that can provide a summary to physicians highlighting at which hospital patients are trending downward and need immediate assistance, or flagging all of their patients that need a preventive screening like a mammogram, or ensuring that patients at risk for MRSA—even those without an infectious disease—are being properly screened? What about a system that forces physicians to reconcile medications before discharge and factors in genetic information when prescribing medications?

In an ideal setting, electronic health record systems could even highlight similar past exams so physicians can make decisions based on the evidence and continually develop best practices.

Some of these tools are already in use at leading healthcare organizations. But for the vast majority of healthcare facilities, decision support is still in its infancy—if it's in use at all. The healthcare industry can no longer afford to sit back and say, "Wouldn't it be nice if we could do this or that," or wait for vendors to develop the ideal decision-support software. Having tools in place that can help clinicians steer clear of medication errors, avoid ordering duplicative tests, and choose the best treatment protocol for patients will be a key element in attaining "meaningful use" from EHR systems by improving quality, care coordination, and reducing costs.

How the technologies required by the HITECH Act are used is critical, says Stephen Tranquillo, vice president and chief information officer at Thomas Jefferson University Hospital Inc., a 957-licensed-bed academic medical center based in Philadelphia.

"The tools need to be used properly in order to improve healthcare and quality and safety and not just as a vehicle to acquire more technology funding," he says.

Implementing an EHR system will not be sufficient to realize the savings and quality gains that the healthcare industry is seeking.

"You have to have a dedicated decision-support and optimization team to really get meaningful use out of it," says Richard Vaughn, MD, the corporate vice president for clinical decision support at St. Louis-based SSM Healthcare and the medical director of Project Beacon, the 20-hospital system's transformation to an EHR system.

That is why the HIT Policy Committee's recommended meaningful use guidelines require organizations to have at least one decision-support tool, explains Vaughn. "They want to make sure that you have that team in place."

Lack of tools
But giving clinicians decision-support tools is not an easy task. Just ask John Haughom, MD, senior vice president of clinical quality and patient safety at PeaceHealth, a seven-hospital system based in Bellevue, WA.

PeaceHealth started building its retrospective decision-support tools in 1997, after its first EHR implementation in 1996. Unfortunately, there weren't any top-shelf products available.

"We couldn't find anyone doing it," says Haughom. So PeaceHealth began building its own data warehouse internally. It's based on the Microsoft SQL Server database and it has been one of the fastest-growing projects at PeaceHealth. Today, it collects data from all of the core systems including the EHR, and it has a series of tools to analyze data, including reporting, trending, data-mining, and dashboards.

"We have several terabytes of data that people use routinely to guide decisions," says Haughom, adding that the program is fundamental to all of the health system's improvement efforts.

PeaceHealth is also providing clinicians real-time decision support through a product that is fully integrated with its EHR from GE Healthcare. The system enables PeaceHealth to write expert rules in both inpatient and outpatient settings. The expert rules can point out drug conflicts and worrisome trends, explains Haughom.

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