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CDS Technology: A Value Proposition for MU

Posted on June 19, 2014 I Written By

The following is a guest blog post by Bonnie Briggs, Director of Product Management for Wolters Kluwer Health.

As the industry turns towards Stage 2 Meaningful Use (MU) attestation with greater urgency and anticipates the forthcoming criteria for Stage 3 and beyond, healthcare providers are increasingly looking for effective ways to streamline compliance and best position for the future. With so many initiatives competing for limited dollars, the value proposition of any health IT investment is critical to meeting current and future regulatory objectives—and qualifying for attractive incentive payments that can deliver a whopping $7 million to the average 200-bed hospital for Stage 2 alone (based on the current Medicare share and transition factor).

As MU moves past the Stage 1 focus of basic data capture within an EHR, healthcare organizations need to lay a foundation to address the more advanced clinical processes and improved outcomes focus of Stages 2 and 3. Use of clinical decision support (CDS) technology at the point of care is a focal point of compliance as it sets the stage for greater adoption of evidenced-based practices to improve outcomes.

While drug reference and drug interaction data applications are obvious choices for meeting Stage 2 MU CDS requirements for drug-drug, drug-allergy and drug-disease interactions screenings, healthcare organizations need to consider that not all solutions are advanced enough to address other key MU requirements, namely patient education/engagement requirements and HL7 Infobutton capability. Specifically, the industry’s most advanced products can help fill in the gaps by providing appropriate tools for educating and engaging patients and linking clinicians to the most relevant content.

Addressing Patient Education and Limited Health Literacy

Industry research reveals that there is a considerable disconnect between the language of clinicians and the ability of patients to comprehend the relevance and importance of what is being communicated. In fact, nearly half of American adults have some level of limited health literacy when it comes to using and understanding written health information alone, according to the Institute of Medicine (IOM).

One area that has become a focal point of regulatory discussion related to patient education and health literacy is the need to accommodate non-English-speaking patients. The National Standards on Culturally and Linguistically Appropriate Services (CLAS) states that “health care organizations must make available easily understood patient-related materials and post signage in the languages of the commonly encountered groups and/or groups represented in the service areas.”

While Stage 2 MU requirements call for the use of EHRs to identify patient-specific education resources, Stage 3 recommendations released by the HITPC Meaningful Use Workgroup earlier this year point to the potential of this rule being expanded to support language needs. Specifically, the recommendation calls for the “use of CEHRT capability to provide patient-specific educational material in non-English speaking patients’ preferred language.”

When considering the value proposition behind the use of CDS technology in the form of drug reference applications, the availability of consumer-level content that addresses a broad array of foreign languages should be considered to best position for compliance going forward. Industry recommendations also suggest that materials be written on a 5th to 7th grade level, using simple sentence structures and short, bulleted statements for easy reading. Other key considerations for effectively engaging patients include age-appropriate illustrations and the provision of materials in larger fonts for the visually impaired.

The Infobutton Challenge

Compliance with MU patient education standards also means that certified EHRs must support the Health Level 7 International Context-Aware Knowledge Retrieval standard, more commonly referred to as the HL7 Infobutton. This industry standard must be used to access patient-specific education materials based on relevance. It may also provide links to referential CDS as an option.

A widely accepted and adopted standard, the Infobutton essentially enables EHRs to generate a view of a patient encounter based on standard patient and provider information. From that information, an EHR application can gather appropriate patient education materials based on the specific details of that case at the click of a button.

The challenge for healthcare organizations will be identifying CDS applications that are equipped to gather patient data in this way. When advanced drug reference applications can aggregate this information from problem lists, medication lists and laboratory results and support Infobutton contextual parameters for identifying appropriate knowledge resources, the value proposition as it pertains to MU compliance is heightened.


When positioning for effective use of CDS at the point of care to meet current and future MU objectives, healthcare organizations need to be careful of making knee-jerk decisions and consider the best technological foundations for long-term success.

While a number of CDS applications on the market can address the basics of drug-drug, drug-allergy and drug-disease interactions screenings, not all are equipped for the broader patient education focus currently unfolding. Considerations should be made for addressing the bigger picture of health literacy and evolving industry standards such as HL7 Infobutton capability.

Bonnie Briggs, RPh, MBA, is the Director of Product Management for Wolters Kluwer Health. She can be reached at

Structuring for the Future of Clinical Decision Support (CDS)

Posted on May 10, 2013 I Written By

John Lynn is the Founder of the blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of and John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

The following is a guest post by Adam Lokeh, M.D., vice president of clinical development and informatics with Wolters Kluwer Health.

Clinical decision support tools (CDS) play an increasingly critical role in a healthcare organization’s overarching strategy to comply with federal incentive programs and succeed within the quality- and performance-based reimbursement landscape currently unfolding. When effectively aligned with physician documentation practices at the point of care, these tools can have a powerful impact on error reduction, the standardization of evidence-based practices, quality of care and ultimately saving lives.

Research reveals that a combination of advanced CDS technology working in tandem with computerized physician order entry (CPOE) solutions will be needed to successfully navigate the coming healthcare landscape. A number of CDS elements will need to be considered and integrated into existing systems to create this powerful collaboration including evidence-based order sets, alerting systems for medication management, ECA rules (event, condition, action), referential information including guidelines and care plans, smart documentation and surveillance technology to name a few. To fully leverage the advantages of these tools, it’s important to understand the different approaches to data and content and the inherent advantages and disadvantage of each.

Currently, there are two approaches to content when designing point-of-care IT infrastructures—structured and unstructured. While both have the potential to standardize care and improve decision-making, industry preference leans toward greater integration and use of structured content for its ability to lay a foundation of improved accuracy, efficiency and ability to drive clinical decision support and analytics.

Because structured content is tagged or coded data that resides in a fixed field, it can be easily located, identified and understood, simplifying the process of integrating content into existing systems and sharing between disparate systems. In contrast, unstructured content, such as free text, often results in irregularities and ambiguities that make it harder to interpret.

Unstructured data makes it more difficult for health IT systems to recognize shared data, requiring complex and largely manual conversion processes that are prone to errors, resulting in inaccurate data. When inaccurate patient information is then shared between systems, the potential for adverse events or care issues is only compounded.

While the premise of this discussion as it relates to the benefits of structured content would seem clear, it’s not that simple. Physicians want the ability to express themselves freely when documenting, and there is concern within the physician community that the full patient picture could get lost if the narrative is too highly structured. As a practicing physician, I understand the delicate balance that exists between the need for a technological foundation that promotes accurate information sharing and the desire to protect the individual patient story.

The truth is that there can be risk without allowing for flexibility in creation of narrative content.  Poorly-designed interfaces have clearly existed with some structured content frameworks historically—and still do today within some CDS and CPOE applications—that can cause pieces of the patient narrative to get lost. The use of applications lacking in flexible design and without trustworthy content that is thorough and exhaustive in nature has led to poor physician perception and even fear that the technology will marginalize patient care. Ultimately, the end result is poor physician adoption.

That is why it is so critical that vendors work with physicians to identify all essential elements as well as the factors that can hinder adoption.  The solution is new, thoughtful clinician-designed systems that are more intuitive and flexible, allowing some limited unstructured content to help flesh out the narrative.

When CDS technology is developed through this kind of high-level partnership and designed to accommodate the use of structured content where it is needed most, content can be indexed at a granular level, easing the process of mapping within systems.  It also lays a foundation for automated updating of content as industry evidence changes and provides a framework for more robust reporting due to extensive filtering capabilities.

The end result is more accurate and efficient integration of the best industry evidence at the point of care, delivering a framework for decision support that truly impacts care without compromising the patient narrative. It’s this kind of far-reaching potential—currently offered through some of the more advanced CDS and CPOE applications in the industry—that physicians need to witness to truly understand what can be accomplished. Unfortunately, the industry has not done a very good job of educating them to date.

Some are looking to the potential of natural language processing (NLP) to address the needs for mapping in free-text environments through data mining. While this path offers an alternative, it is not as powerful a foundation as structured content for improving decision making at the point of care. In fact, it’s retroactive. If data mining occurs after the patient narrative has already been input, decision support can, by definition, only be offered “after the fact.”

In essence, physician documentation that is completed in a structured-content environment —as opposed to a traditional dictation method—is, in itself, a form of CDS. Because documentation can be structured to guide and remind physicians to document important medical elements, it assures that nothing is overlooked.

Many industry initiatives point to greater incorporation of structured content into the design of IT applications for information exchange. Industry movements and organizations such as Meaningful Use, HL7, the Standards and Interoperability (S&I) Framework Health eDecisions Project and the CDS Consortium are working towards industry standards that will require use of more structured content.

The simple fact is that when data is shared, it has to be recognized across and between systems. Structured content within CDS applications allows data to be mapped to a standardized vocabulary to ensure accuracy.

That said, clinicians prefer free text. Until the industry properly educates physicians regarding the power inherent in structured content, the best approach will be a hybrid that includes avenues for both models. For maximum adoption, IT vendors should consider that critical components will need to be structured to drive CDS, reporting and quality metrics, but allowing for some amount of free text to smooth out the edges for more widespread adoption.

Hospitals, Health Systems And Clinics Adding Portals, But Consumers Not Synched Up

Posted on December 17, 2012 I Written By

Anne Zieger is veteran healthcare branding and communications expert with more than 25 years of industry experience. and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also worked extensively healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or

With Meaningful Use Stage 2 requiring that 5 percent of patients use them, a growing number of health systems, hospitals and clinics have rolled out patient portals, according to a recent study by KLAS. In fact, 57 percent of providers now offer a portal, typically connected to their enterprise EMR, KLAS found.

The thing is, somehow these efforts aren’t reaching consumers. In a new Wolters Kluwer Health survey of 1,000 consumers, only 19 percent said that they have access to a personal health record.

It’s not that patients don’t want to be engaged in their health — 80 percent of respondents said greater control of healthcare is positive — but it seems that they either don’t like or don’t know how to find the portals available to them.

Ultimately, the broad mass of consumers simply don’t seem to see a crying need to use portals as of yet. Seventy-six percent of respondents to the Wolters Kluwer survey said that they have the information and tools they need to manage basic healthcare functions such as choosing providers and researching treatment options, clearly dwarfing the number who care to look at their own patient data.

That being said, there’s a small (but I’d argue, growing) minority of patients who do take connections with providers seriously. Nineteen percent of respondents told researchers that the ability to communicate via e-mail with doctors and nurses and schedule appointments online was an important factor in choosing a medical practice. In other words, there’s clearly a wired contingent out there which would probably respond well to a truly useful portal.

How can hospitals and clinics get patients engaged in PHR use?  My gut instinct is that consumers won’t give a hoot about PHRs until they become a tool that’s part of their medical or hospital visit. If doctors work with a PHR, turning the visit into a collaboration, patients will be motivated to follow up and review what they’ve learned.

I guess what I’m saying is that we should start by getting doctors engaged with PHRs as a means of getting patients involved. If they do that, PHRs will go from being some Web site to a valuable tool for sharing care information.  If not, don’t expect the number of PHR-interested consumers to climb anytime soon.