EHR prompts improve chronic disease management and preventive care at Michigan Medicine

February 6, 2018  //  FOUND IN: News

Something exciting is happening at Michigan Medicine. And U-M patients are benefiting.

In recent months, the screening rate for depression symptoms in patients who had diagnosis of depression in the last 12 months rose to nearly 70 percent. The rate of lung cancer screenings in smokers doubled. And the hepatitis C screening rate improved fivefold among Baby Boomers, as well as increasing following specialty care for infected patients.

These are just some of the improvements largely attributed to clinical decision support, or CDS, a key functionality of health information technology delivered through the electronic health record (EHR), MiChart. When applied effectively, CDS increases care quality, enhances health outcomes, helps avoid errors, improves efficiency, reduces costs, and boosts provider and patient satisfaction.

David Serlin M.D., assistant professor of family medicine, said he finds CDS incredibly helpful. “In primary care, we are responsible for 42 quality metrics. It can be hard to remember which of the 42 a patient needs in any given situation. (CDS) reminds us what patients are due for in a 20-minute office visit.”

CDS benefits both chronic disease management and preventive care. During a diabetic patient’s appointment, for instance, her care team may be prompted to do a foot exam, eye exam, urine screen, sugar check and medication review. They may also receive a prompt if the patient is due for a Pap smear or mammogram.

Providers across the country are under an increasingly heavy workload. That’s in part due to changes in reimbursement as well as an explosion of medical knowledge. Health care is transitioning to value-based reimbursement, which is determined by a combination of cost and quality measure performance.

“While there is a lot of money riding on quality of care, the bottom line is it’s the right thing to do for our patients,” Serlin said. “If we do this right, the health system brings in more money, patients have better outcomes, and (providers) benefit from the satisfaction of providing good care and bringing in more revenue to support our clinical infrastructure.”

Cheryl Dehmlow, one of the analysts working on population health management in Health Information Technology & Services (HITS), focuses on clinical decision support for preventive care and chronic disease management in ambulatory care.

“The role of clinical decision support is to offer cues of what the patient is due for and make it very easy for the provider or care team to take the next step to help the patient fulfill those needs,” said Dehmlow. “The EHR alerts are not the decision, they’re the support. They do not require a provider or care team to do anything. They simply assist their decision making.”

There are four primary types of CDS: best practice alerts (BPAs), health maintenance (viewed in MiChart and delivered to patients through the patient portal), panel quality dashboards (reports that show which patients are overdue for standard preventative care or disease management), and drug-drug/drug-allergy alerts (when a prescribed drug interacts with another drug or allergy listed in the patient’s chart).

“I don’t approach CDS in terms of what the technology can do. I want to understand the clinical objective and who are the clinical support users who naturally play a role in meeting that objective so we can help assess if – and what kind of – CDS is the right intervention,” Dehmlow said.

Population management clinical decision support is guided by the “CDS Five Rights” to ensure the right information is provided, to the right people, in the right intervention format, through the right channel at the right time.

This is key to physicians like Greta Branford, M.D.

“Providers tend to have a love/hate relationship with CDS,” said Branford, instructor in internal medicine and pediatrics and communicable diseases. “We hate to be stopped in our tracks and don’t like interruptions, but at the same time if the alerts are reliable, predictable, and provide a good reminder, we trust them and they become very useful.”