In the Physician Executive Council's 2016 survey of chief medical officers, it's no surprise that quality improvement, medical staff affairs and burnout, and care variation reduction topped the list of the CMO's most time-consuming and strategically important responsibilities. Clinical leaders have made notable improvements in these areas, but one tool—clinical decision support (CDS)—remains a grossly underutilized lever to advance the CMO agenda.
CMOs generally steer clear of health IT and informatics, often leaving these responsibilities to the CMIO. But the case for greater CMO involvement in CDS is compelling: The relative effectiveness (or ineffectiveness) of CDS can make or break our efforts to influence quality, physician burnout, and care variation reduction—the CMO's three most time-consuming and strategically important responsibilities.
CDS can make the CMO's agenda…
When it comes to quality improvement and care variation reduction, effective CDS can help sustain clinician behavior change and boost quality outcomes by enabling use of evidence-based standards at the point of care.
Effective CDS can also help mitigate burnout. With physicians facing increasing pressure to perform, CDS can help relieve some of the burden by guiding physician workflow, making it easy to do the right thing—and of course reducing the number of clicks in the EHR.
…or break the CMO's agenda
Despite its potential, if we're honest, the current state of CDS leaves a lot to be desired—and hinders the CMO's ability to execute. It's no secret that clinicians struggle with alert fatigue. The constant interruptions by overly sensitive, inconsequential alerts exacerbate already mounting problems of disengagement and burnout.
Notably, there's a growing body of evidence linking alert fatigue to decreased quality and safety. Studies show that over-alerting can result in "habitual alert override." The overwhelming volume of inconsequential alerts causes clinicians to override every alert, instinctively and without reviewing. The ramifications for clinical quality are grave, because providers may automatically override critical alerts, which could lead to adverse outcomes.
Two strategies for improving CDS
With all this at stake, it's important that CMOs embrace a more active, strategic partner role in CDS. Specifically, CMOs should elevate CDS performance on two fronts:
- Reduce the CDS noise: To reduce existing alert burden, health systems need to categorically purge the EHR of low-value alerts (e.g., informational alerts, non-critical interruptive alerts) and fine-tune remaining alerts to improve positive predictive value.
- Build new CDS smarter: Leaders should commit to only building CDS that will truly support overarching organizational goals. In addition, systems need to streamline CDS design and build processes to ensure new CDS is impactful and easy to follow.
Next, learn two ways to identify clinical variation
There are many opportunities to reduce care variation in hospitals today—but how should you prioritize those opportunities?
You should start by examining variation in two ways: "horizontal" and "vertical." A horizontal approach focuses on the use of costly resources across multiple conditions, while a vertical approach analyzes performance within a particular condition or patient population to develop a consensus-based standard.
Our infographic gives an example of each approach and explains the challenges of a horizontal approach versus the benefits of a vertical one.