Clinical decision-support systems were a hot topic last week at the 17th annual Physician/Computer Connection Symposium of the Association of Medical Directors of Information Systems.
Systems discussed included not just computerized physician-order entry, but also more-mundane approaches, including paper-based protocols. One topic was the cost of acquiring and maintaining the knowledge bases that underpin clinical decision-support systems.
AMDIS vice chairman Howard Landa, chief medical information officer for Hawaii Permanente Medical Group, said that in addition to the expense to upgrade and maintain their clinical software, organizations need to figure on incurring a proportionate expense for the maintenance and upgrading of clinical knowledge bases that drive clinical decision support.
You put in a piece of software, you pay 15% to 20% for updates, Landa said. Similarly, for decision-support expenses, If it costs you $100,000 to create it, it will cost you $30,000 a year to maintain it. The value is in maintaining it and upgrading it. Landa and several other AMDIS conferees agreed the new duties of clinical content maintenance are best assigned to the medical records/health information management department.
Jerry Osheroff, chief clinical informatics officer at Thomson Healthcare, said the role of clinical decision support will increase as more and more hospitals install clinical IT systems and the systems become more sophisticated and pressure from employers, accreditation organizations, regulators and patients builds to improve transparency, quality and patient safety.
In 2005, the Healthcare Information and Management Systems Society published Improving Outcomes with Clinical Decision Support: An Implementer's Guide a follow-up, also to be published by HIMSS, with support from the Scottsdale Institute, is expected this fall.
Osheroff said close to 100 people helped upgrade the book, including members of HIMSS, AMDIS, the American Medical Informatics Association, the Institute for Safe Medication Practices and the American Society of Health-System Pharmacists.
The era of people toiling away in isolation is coming to an end, said Osheroff, who envisions creating a Wikipedia-type resource that is dynamic.
Scott Weingarten, president and chief executive officer of Zynx Health, Los Angeles, said that keeping up with clinical decision-support systems, including referential content, structured documentation, computerized alerts and order sets, is now a daunting task.
Weingarten counseled CMIOs preparing computerized-order sets for the first time to persevere.
Whatever you end up with in your initial order set, youre going to miss the mark and youre going to miss it multiple times, Weingarten said. I have yet to meet someone who got it right the first or second time. Youre going to customize it. Before you really get order sets that are usable and acceptable, youre going to have 10 iterations.
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