The Northwest Hospital & Medical Center in Seattle, Wash., is doing some interesting things with clinical decision support (CDS), an area that we expect to have an increasingly positive influence on the Bobbsey Twins of health care: quality and cost. Greg Schroedl, MD, the hospital’s chief medical officer, points to order sets that were created for select conditions: “You can deliver similar care to multiple patients over time where hopefully 95 percent of what you do is repeatable and consistent, with some room for customization and variation if indicated for a particular patient.”
An order set for heart failure would, for instance, specify a low-sodium diet, or that the patient be weighed daily to see if he is retaining fluid. This isn’t just theory for hospitals, as the government’s value-based purchasing and readmissions-reduction programs withhold reimbursements if hospitals don’t achieve specific quality metrics and patient satisfaction scores.
Of course, there’s always the matter of physician buy-in. For a number of years some hospital organizations have used evidence-based order sets on paper, says Schroedl, but physician adoption was low and difficult to monitor. “With today’s computerized evidence-based CDS systems, hospitals can offer to physicians order sets of greater value because they are evidence-based and within the context of their established computerized physician order entry workflow. This has greatly increased physician adoption and therefore the value of the hospital’s investment.”
This is the sort of improvement that both hospital and insurer can applaud. “Certainly, health plans want to keep the costs down for their employer clients,” says Schroedl. “They’re interested in positive outcomes for the patient. For hospitals, outcomes are first and foremost. Positive outcomes can also be associated with lower costs if we look at the totality of the care.”