Student Dissertation

Agency : Clinical Decision Support System; Healthcare Facilities; EMRAM; EMR System; United States

Objective : • To identify and analyze the pressing issues faced by the healthcare facilities in the United States. • To study the emerging healthcare reforms/legislations released. • To disruptively, identify the role of Clinical Decision Support System in enabling healthcare facilities to reach • required MU and EMRAM objectives and become compliant. • To formulate a strategic approach to implementing an integrated CDSS into an EMR system.

Background : In the recent years, Healthcare Systems have seen a paradigm shift in its delivery as well as the working of the complete workflow system. Adoption of an appropriate EMR system is one such advancement, which has changed the face of Healthcare delivery and the optimum utilization of the available resources with overall improved quality of the complete work process flow. As of 2014, EMR systems started sharing data in various forms among themselves as well as across other systems. However, interoperability proved to be the major obstacle universally to realize the true potential of Healthcare I.T. and its effective use. In order to make the facilities compliant to the upcoming regulations and mandate the “meaningful use” (MU) pre-requisites, the CMS came up with various regulations and amendments. CMS established a program to promote the Appropriate Use Criteria (AUC) as directed by Section 218(b) of the Protecting Access to Medicare Act (PAMA) of 2014. As per the legislation, Medicare providers are required to consult appropriate use Criteria (AUC) via a clinical decision support mechanism to order certain advanced diagnostic imaging services. The services covered by this requirement include diagnostic magnetic resonance imaging (MRI), computed tomography (CT), nuclear medicine (including positron emission tomography), and other diagnostic imaging services specified by CMS in consultation with the medical community and stakeholders, but excluding x-ray, ultrasound, and fluoroscopy services. The use of Healthcare IT will not only improve the overall quality of care and reduce the cost incurred in the process, but also waive off the total out-of-pocket expenditure on healthcare in the United States. Clinical Decision Support System (CDSS) has the potential to revolutionize the whole model on which the healthcare industry works. It can provide not only clinicians and staff with exhaustive knowledge in order to aid in their decision-making, but also in a person-specific manner for a specified timeline. The study aims to rule out the issues crippling the hospital’s workflows and the germane federal regulations initiated to bring about a diversion from volume-based care to value-based care. Factors like Financial Challenges, Government Mandates and Patient Safety & Quality; would be considered in the study and the same would be crucial in outlining plans for a consulting firm to gauge the requirements of a healthcare organization and aid in strategizing forthcoming implementations.

Methodology : • Study design: Desk Research Study (Secondary Research) • Setting: Deloitte USI, Bengaluru • Duration of study: 3 months (6 February 2017 to 6 May 2017) • Data collection method: External sources of secondary data including reports and journals.

Recommendations :With the ever-growing potential of Healthcare IT and the upcoming legislations, it is evident that systems like EMRs without an integrated CDSS will not stand in future and will not add value to the clients. EMR systems when integrated with modules like CDSS can be revolutionize the complete face of Healthcare Delivery, improving overall quality and safety for patients and reduce the cost of care delivery by removing all the unnecessary steps present in the process of patient care. Apart from catering to the existing customers CDSS can very well used as an add-on, feature to a vendor’s EMR for a new client. From the above study it can be very well concluded that a CDSS module is a guidance tool, which aids in the process of decision making for the clinicians and does not intervene with the skills or judgment of the clinician, thereby making most of both the worlds of technology and functionality clubbed together for an improved and better future.


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