WINNIPEG, MANITOBA, CANADA – Clinical Decision Support Systems are becoming increasingly popular in health care, in spite of some perceived barriers to acceptance that experts in the area have identified.
Although these barriers don’t exist with Prognition Corp.’s Mavenlive physical therapy rehabilitation exercise software, they are worth mentioning.
A CDSS- an application designed to help health care providers make clinical decisions by analyzing data- must integrate with a health care organization’s existing software, which can be complex, according to SearchHealthIT. A majority of CDSS are stand-alone products that can’t be integrated with reporting and electronic medical records software. If they can be integrated, combining large amounts of data into existing systems can put a sizable strain on application and infrastructure maintenance.
There are two main types of clinical decision support systems: knowledge-based and machine learning to analyze clinical data. Mavenlive is a knowledge-based system, meaning that it applies rules to patient data using an inference engine, says Chris Metcalfe, Prognition’s vice president of technical development. Then it presents the results to the physiotherapist.
Dr. Jay Winburn, president of Prognition, says its PT documentation software is a leader in the support systems arena, thanks to its knowledge-based engine and its ability to fully integrate with physical therapy billing software, PT scheduling software and other software already in use in physical therapy clinics.
Open Clinical lists the four primary roles of any electronic clinical decision support system as follows:
- From an administrative standpoint, these systems should support clinical coding and documentation, procedure authorization, and referrals.
- They should manage clinical complexity and details, such as keeping patients on research and physical therapy exercise protocols, tracking orders, following up on referrals, and preventive care.
- Control costs by monitoring diagnostics, exercise prescription and other therapies. Ineffective treatment and unneeded tests are eliminated.
- Decision support- support the clinical diagnosis and treatment plan process; promote using only the best practices; condition-specific guidelines; and population-based management.
“We view CDSS as the wave of the future, due in part to the Health Information Technology for Economic and Clinical Health Act, which states that health care providers are required to show they are using health IT by 2015,” Dr. Winburn says. “If they can’t demonstrate this measure, they will be subject to reduced Medicare reimbursements starting in 2016.”
While demonstrating a “meaningful use” of CDSS and other health IT may seem a bit ambiguous, the HITECH Act offers some guidelines for meeting the benchmark, he says. Health care practitioners must implement one clinical decision support rule, including diagnostic test ordering, along with the ability to track compliance using the rule. The act states that the rule should apply to a specialty or high-priority condition.
When implemented and used to its fullest extent, CDSS offer benefits beyond maintaining current Medicare reimbursement levels, Dr. Winburn says. They carry significant patient treatment benefits.
For example, the fact that Mavenlive is a cloud-based CDSS makes it possible for physical therapists to share knowledge with each other. If one PT has developed a regimen of rehabilitating patients following knee replacement surgery, he/she can share prescribed exercises with other clinicians.
If a therapist develops new exercises, they can be entered into the system for others to use when necessary. As exercises are entered into the system, the knowledge engine recalls them and lists them as potential exercises to prescribe, based on the patient information entered by the therapist, Dr. Winburn says.
“Although CDSS has been around for several years now, it’s still in a growth stage,” Metcalfe says. “Technology continues to improve and CDSS continues to provide helpful solutions.”
To be really useful, however, it needs to be available in real-time at the point of care. This is where Mavenlive’s cloud solution excels. The physiotherapist doesn’t need to be sitting by a super computer; it exists in the cloud. The only thing needed is access to the Internet. A tablet, which is not a powerful computer, is the ideal device to access the cloud. Because Mavenlive also documents the patient visit, data doesn’t need to be entered more than once. The same data that documents the assessment is used by the knowledge engine to suggest evidence-based therapy.
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