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What to Consider When Evaluating Clinical Decision Support Tools

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What to Consider When Evaluating Clinical Decision Support Tools

Clinical decision support (CDS) is redefining the relationship between physicians and health plans, and industry professionals and patients. It improves the flow of information and facilitates patient data capture that provides clinicians what they need to treat patients, and health plans what they need to properly risk adjust and document patient needs.

CDS tools are being included in a variety of healthcare technologies, including Signify Office. When evaluating any new technology for your provider network, you should look for CDS to be implemented throughout the solution.

Clinical Decision Support Defined

To put it succinctly, clinical decision support is any tool that provides clinicians and staff with knowledge and patient-specific information, intelligently filtered, and presented at appropriate times, to enhance health and healthcare.

Clinical decision support provides the following benefits: 

  • Enhances health outcomes for the member network
  • Improves physician documentation quality
  • Reduces costs and helps avoid errors and adverse events
  • Optimizes in-office annual evaluation efficiencies
  • Boosts provider and member satisfaction

Clinical decision support tools can take many forms, but what they all share is their ability to help enhance outcomes and improve documentation quality. Examples of such tools include:

  • Computer-assisted calculations
  • Data validation prompts
  • Real-time documentation conflict and insufficiency resolution
  • Computerized alerts and reminders for clinicians and patients
  • Configurable forms based on factors such as demographics and diagnosis history
  • Diagnostic support

CDS tools help reach better outcomes, achieve better documentation, and save costs. The best tools help encourage physician participation by enhancing their work, not intruding on it.

Risk Adjustment and PCP Documentation Support

Currently, health plans and physicians face a series of hurdles when it comes to documenting patient conditions. The largest is the disconnect between what’s needed to calculate an appropriate risk score for a health plan member, and what physicians need to treat members.

The HCC risk adjustment model is based on ICD-10 coding, while the physician office world is focused on CPT and E&M. This can result in a disconnect in coding practices. CDS tools help bridge this gap because they can prompt physicians for additional specificity needed for risk adjustment.

For example, a member visits their PCP complaining of a depressive episode. If the diagnosis of major depression is documented without severity, recurrence, or remission status, the documentation does not meet criteria sufficient for HCC risk adjustment coding. A good CDS tool will prompt the physician to elaborate and does so specifically based on what’s entered.

What To Look For In Clinical Decision Support

Different CDS tools will offer a variety of features, and it’s important to take a deeper dive to ensure you are getting a tool that meets the variable needs of your physician network as well as the members themselves. Here are five things to look for when choosing a CDS tool:

Adaptability

There are a variety of strategies when it comes to increasing documentation accuracy, making the lives of physicians easier, and improving patient health outcomes. The best CDS tool will provide the ability to adapt to different situations and fit into the existing workflows your physician offices have created.

Stays Ahead of Change

There is always change in healthcare, from technological advancements to regulations. It’s important that CDS stays ahead of these changes. Is it updated to anticipate shifts in the industry proactively or reactively?

A great example are the changes to HCC coding in 2019. A CDS tool should be looking for these changes as they are announced, ready to support physicians and health plans as they take effect, not after.

Progressive Tools

Look into how easy a CDS tool makes it for you. Progressive tools help ensure that the correct questions are being asked, the right data is being collected, and in a way that supports all parties involved.

Progressive tools look at what physicians are answering and prompt follow-up questions to make their lives easier without intruding on the experience for the patient. For example, if documentation indicates the member is currently using alcohol, the CDS tool should automatically suggest the CAGE Screen. This expedites documentation and creates a more seamless experience.

Payer Agnostic

Asking physician groups to use a plethora of tools, one for each health plan they work with, is daunting, leads to burnout, and cuts into time that could be spent creating better health outcomes.

A tool that’s uniform and easy to use for physicians and their staff will help to improve the adoption rate with less friction.

Clinical Documentation and Signify Office

Clinical decision support is becoming an essential part of obtaining proper clinical documentation. If you are interested in adding CDS to your toolbox, Signify Office is a healthcare technology solution that improve documentation accuracy while optimizing member outcomes with fully-integrated clinical decision support functionality.

Capture more accurate diagnostic data, reduce costs for your highest-risk members, and improve quality of care.

Burke Burnett
Burke Burnett
Director, Strategic Product Development