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Completing the Circle

January 10, 2012
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A Medical Research Study Looks at IT-Facilitated Hypertension Control in Community Health Centers


Here’s encouraging news: while those of us in the know have long known that clinical decision support works, more and more, there’s evidence to prove it. Take for example the findings of a recent study published in the December issue of the American Journal of Managed Care (AJMC).

A group of ten healthcare researchers, led by Donna Shelley, M.D., M.P.H., conducted a study in a four-site, federally qualified health center organization called Open Door Family Medical Centers, in New York. Shelley and her colleagues wanted to assess “the impact of an electronic medical record (EMR) with clinical decision support (CDS) and performance feedback on provider adherence to guideline-recommended care and blood pressure control compared with a standard EMR alone.”

Here’s what happened: Shelley and her colleagues looked at clinicians’ use of a clinical decision support system that included a blood pressure alert, a hypertension order set, a hypertension template, and clinical reminders; and they looked at patient-level data encompassing encounters 17 months prior to the implementation of the intervention and 15 months post-intervention.

And the researchers found that rates of hypertension control were “significantly greater in the post-intervention period compared with the baseline period.” Specifically, patients covered by the study were 1.5 times more likely to have controlled blood pressure post-intervention than pre-intervention, based on the use of the concert of tools involved. Those tools included:

> alerts,  highlighting an elevated blood pressure reading in red for the clinician;

> a template, to present the provider with the blood pressure information needed to be gathered from the patient;

> medication adherence forms, “to prompt clinical support staff to ask patients about taking their medications and document the responses”;

> an order set focused on hypertension, “allowing the provider to access a single screen when ordering tests or treatment”; and

> clinical reminders, "to prompt providers to screen for tobacco use and/or update indicated tests (e.g., lipid profile).”

There are more details involved in the study, which are very much worth reading about, including how the CDS implementation was managed, including its training aspects, by the health centers involved. But it’s the overall “results” section of the AJMC article that is most intriguing. As the authors note, “We found improvements in most of our process measures, suggesting that clinicians were activated by the intervention to change practice patterns.” Translation: when the right clinical decision support systems are put into place, physicians and other clinicians naturally change their workflow and practice patterns to do the right thing.

I look to more and more studies like this being performed, for two reasons. First, they will continue to encourage both healthcare IT leaders and the front-line clinicians who need to accept clinical information systems and make them successful. Over time, the weight of these studies should help to diminish remaining resistance at least to the concept of CDS. Second, well-designed studies like this one in the AMJC should also be able to provide healthcare IT leaders with some specific clues as to what specific elements work best in specific situations.

Most of all, it’s becoming more and more clear that, as medical and clinical practice advance through the facilitation of the best kinds of clinical decision support, more and more research like this will emerge to document the power of CDS to improve patient care.