Clinical decision support, a key component in the electronic health records meaningful use criteria, still faces some significant implementation challenges, based on the results of two demonstration projects by the Agency for Healthcare Research and Quality.
Both projects "demonstrated the ability to translate evidence-based knowledge into useful, actionable guidance for clinical care through" clinical decision support (CDS), according to a report detailing the results of the projects. Further, the projects demonstrated the value of working with professional associations and guideline developers to provide tools and guidance for improving CDS development and clinical quality reporting. They also highlighted the value of aligning clinical quality measurement with CDS implementation.
However, the projects also demonstrated that while centrally developed CDS "is feasible, customization of CDS is still required on a site-by-site basis" to account for the need to customize the CDS app to local electronic health record (EHR) systems and to follow local data-coding conventions and practices. This can be "very labor intensive," the report noted.
Other significant challenges revealed by the two projects were "major difficulties" encountered when clinical guidelines were updated. "These implementation challenges point to the need for additional work on developing standards for EHR design, terminology, and data coding," the report said.
The two projects also encountered challenges associated with local variations in clinical workflow.
"It is essential to understand early in the implementation process when in the course of clinical care the data elements needed by the CDS tool are entered into the EHR system, and when it is appropriate for the decision support to appear," the report stated. "Similar considerations will also dictate to whom the decision support should be addressed."
Legal issues related to intellectual property, liability, and other concerns "merit further discussion and policy development," the report added."