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"Care providers are very data driven and our experience has been that they'll get energized around improving the quality and safety of care, but they want data to, No. 1, confirm there is a problem, and No. 2, confirm that they are making a difference," says Haughom.
Decision-support tools may be a little bit easier to come by today, but not much.
"It is not something that is coming out in the model systems," says Vaughn, adding that the decision-support tools that are built into vendor systems are still very basic.
Lack of readiness
But even if there was better software available, most healthcare facilities aren't equipped to use it properly. Organizations can't do decision support effectively unless they have 100% physician order entry, says Mary McNichol, senior director of information systems at TJUH.
While the College of Healthcare Information Management Executives found that more of its members have CPOE "at some level of adoption" than previously thought, many of those respondents were still years away from 100% adoption—only 8.5% of respondents said they believed it could be achieved in one year.
Most healthcare facilities are still working toward the first stage of decision support, which basically consists of implementing an EHR that puts old information into an electronic format where caregivers can retrieve it, says Haughom.
"That is what I'd refer to as a passive form of decision support, because it is not actually presented back to the caregivers. They have to go find the data." Still there is value in having one location for clinical data, he says.
Haughom refers to the second generation as the one "where the value of EHRs is going to come alive." That is where pioneers like PeaceHealth, TJUH, and SSM are currently making inroads by using expert rules and, in some cases, retrospective decision support to push out information to providers. TJUH pushed out its first decision-support rule in 2003.
"Primarily, we use them for patient safety, efficiency, and compliance," says Arlene Peters, clinical applications manager in information systems. The EHR product can check for drug-to-drug interactions and allergies, and TJUH can supplement those programs with expert rules that prevent physicians from ordering physical therapy for a patient on bed rest, for example.
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