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CMIO/CHIO Summit: Managing Clinical Decision Support and Improving Workflow

December 27, 2016
by Trudy Millard Krause, UTHealth School of Public Health
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The Scottsdale Institute CMIO/CHIO Summit set out to foster collaboration among chief medical information officers and chief health information officers from prominent healthcare systems across the country

Executive Summary: Twenty chief medical information officers (CMIOs) and chief health information officers (CHIOs) of leading health systems gathered in Chicago this past fall to share best practices and lessons learned regarding clinical decision support (CDS) and improving clinical work flow. This report captures their discussion and shared insights.

Summit participants: David Classen, M.D., Pascal Metrics and University of Utah; Greg Forzley, M.D.,  Trinity Health, Anupam Goel, M.D., Advocate Health Care, Greg Hindahl, M.D., BayCare Health System; Kim Jundt, M.D., Avera Health; Michael Kramer, M.D., Spectrum Health; Michele Lauria, M.D., EasternMaine Healthcare Systems; Thomas Moran, M.D.; Northwestern Medicine; Nnaemeka Okafor, M.D., Memorial Hermann Health System; Theresa Osborne, M.D., Spectrum Health; Jerry Osheroff, M.D., TMIT Consulting, LLC, Luis Saldana, M.D., Texas Health Resources; Anwar Sirajuddin, Memorial Hermann Health System; Andy Spooner, M.D., Cincinnati Children’s Hospital Medical Center; Peter Springsteen, M.D., Munson Healthcare; Pete Stetson, M.D., Memorial Sloan Kettering Cancer Cente; Jeffrey Sunshine, M.D., University Hospitals; Randy Thompson, M.D., Billings Clinic; Paul Veregge, M.D., Catholic Health Initiatives; Alan Weiss, M.D., Memorial Hermann Health System

Organizer: Scottsdale Institute; Sponsor: Deloitte; Moderator: Deloitte (Ken Abrams, M.D.)

Introduction: The Scottsdale Institute CMIO/CHIO Summit was held in Chicago on September 30, 2016. The objective of the Summit was to foster collaboration among chief medical information officers (CMIOs) and chief health information officers (CHIOs) from prominent healthcare systems across the country, with the intention of learning from shared experiences, best practices and proven approaches.

The group was tasked with reviewing the maturity of the clinical decision support (CDS) processes within organizations that responded to a pre-summit survey. Based on those findings a productive discussion evolved regarding CDS and lessons learned. Future visions and emerging trends and technologies were explored, along with the impact to CDS and the CMIO/CHIO role. The impact of future payment policies such as MACRA and bundled payments on information systems was also explored.

Throughout the Summit, underlying themes stressed the importance of CDS in patient outcomes, physician performance, organizational quality metrics and, ultimately, reimbursement strategies. This critical component thereby requires organizational commitment and support along with evolving strategies for system improvement and sustainability to meet future demands and opportunities.

Pre-Summit Survey Results

In advance of the summit, the Scottsdale Institute circulated a survey among CMIOs and CHIOs regarding CDS with the intention of collecting information to initiate fact-based discussion during the summit. The survey was written by Dr. Michael Kramer, Dr. Nnaemeka Okafor, Dr. Luis Saldana, Dr. Anwar Sirajuddin and Dr. Alan Weiss. Twenty-two responses were returned. The responses indicated there were varied levels of maturity in CDS implementation and design. A summary of responses follows:

> The most frequently identified knowledge-management system used for CDS was an EHR tool such as Epic or Cerner, but other responses reported using tools such as Word, Excel, Tableau or others.

> CDS project-management initiatives were most frequently organized by steering committees or councils, but the majority of responses varied greatly.

> 59% of respondents reported that the CDS elements were not reviewed on a regular basis.

> 65% reported that very minimal customization of the CDS tool was allowed across hospitals or practices.

> 68% stated that the organizational approach to alerts and CDS was a combination of “buy” and “build.”

> Among the value-added decision support initiatives that showed a return on investment (ROI), Sepsis and VTE ranked as the top two.

> Analytics for Radiology was the top area of CDS that was being considered by the respondents.

> 73% felt that ACR Appropriate Use Criteria were the most appropriate for radiology.

> 89% were not incorporating cognitive computing or artificial intelligence.

> 50% reported limited activity around consumer related data integration such as patient monitoring.

Discussion on the survey results pointed out the great variation in maturity in CDS system integration. Dr. Jerry Osheroff noted the CMS-recommended “CDS 5 Rights Framework” is a very helpful guide to shape CDS to drive performance and quality. The spectrum of maturity levels can be seen in each of the 5 CDS Rights dimensions. The challenge: “Make the RIGHT thing to do the easy thing to do!”

Dr. Michael Kramer noted that very few organizations assess all the 5 Rights during the development. Even less common is some form of evaluation to see if the rule continues to fire. In one example, a health system’s lab-test names changed but the rule was not updated. Important safety and quality outcomes can become unreliable without anyone knowing the system configuration has changed.

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