HCLF: CDS, IT to reduce disparities, meet MU

CHICAGO—The ultimate vision of the Meaningful Use program is to create significant and measurable improvements in population health through a transformed healthcare delivery system, said George Hripcsak, MD, MS, chair of the department of biomedical informatics at Columbia University. Hripcsak spoke during the Healthcare Leadership Forum on Nov. 15.

“The timing of MU criteria is a balancing act,” he said, discussing the need to require increasing requirements without pushing providers too hard. Much discussion had occurred over the years to ensure the criteria and requirements are clear and continue on the path toward that ultimate vision.  

Commenters have addressed vague requirements and Hripcsak said the program changed directions in August when the Health IT Policy Committee increased its focus on reducing disparities.

Part of the problem is a gap between recommended, evidence-based practice and current practice, Hripcsak said. The number of tasks that must be performed to comply with quality goals and regulatory requirements is increasing, including medication reconciliation, pneumococcal and influenza vaccination, beta-blockers after myocardial infarctions and HIV testing.

To manage, Hripcsak’s organization created an electronic quality checklist to help clinicians efficiently address the increasing number of quality recommendations and compliance requirements. This checklist has clinical sponsors, provides a patient-specific “one-stop shop” for multiple initiatives and distributes knowledge and accountability across entire care team.

Hripcsak said observations have shown that standards alerts are overridden 90 percent of the time if they are not hard stops. FluAlert, which was designed to fit in providers' workflow as a floating pop-up during note writing, was used two-thirds of the time, even though it’s not a hard-stop. “Patient verification has worked well, but adds increased time for order writing.” The quality checklist tries to provide a one-stop shop for various clinical decision support (CDS) but “the jury is still out on its effectiveness.”

CDS is essential to transformation, he said, and is challenging. “The process of selecting, developing and installing the system can be as important as the decision support itself–delivering accurate advice is essential to avoid alert fatigue–the distinction between decision support and the rest of the record is blurring.”

The Healthcare Leadership Forum was sponsored by ClinicalKey and presented by Clinical Innovation + Technology.