Editor’s Note: This is the second in Rimidi’s series on CDS Hooks, a new FHIR-based specification that describes how EHRs can automatically invoke external platforms or applications.read The first article is here.
Healthcare providers continue to be pushed to their limits. Many work long hours, care for a growing number of patients, manage through labor shortages, and deal with growing administrative tasks. While their workloads are full, they now also need to assess increasingly difficult-to-maintain volumes of data—from content in electronic health records (EHR) to information generated by consumer and home medical devices, and the ever-evolving Evidence and guidelines – all with the aim of providing the highest quality care.
To standardize and connect these disparate sources of health data, the industry adopts Rapid Healthcare Interoperability Resources (FHIR) as the preferred protocol for application programming interface (API) based data exchange. FHIR enables electronic health records, digital health applications, patient-reported outcome measures, healthcare payers, and consumer devices to seamlessly exchange structured health information.
Bringing together data from disparate systems is just the basic step. The value begins with how this aggregated data drives improvements in patient care and clinical workflows. Clinical Decision Support (CDS) is a key concept in realizing this value. CDS Hooks define clinical decision support criteria for HL7 FHIR. This is FHIR’s “so what” as it allows information, insights and actions to be driven in the right patient context at the right time in the clinician’s workflow. CDS Hooks will help support the ongoing shift to value-based care as we continue to target overall improvements in cost-effectiveness, provider efficiency, patient outcomes and the healthcare value equation.
Clinical decision support system adoption lags
CDSS has grown rapidly since its debut in the 1980s.However Decision support has not yet been widely adopted For a variety of reasons. One of the main challenges is that CDSS can disrupt the clinician’s workflow if it is not integrated with the EHR and requires additional documentation beyond traditional workstations. Even if CDSS and EHR work together, decision support tools can be more disruptive than useful if they are not patient and context-specific.
up to 95% of CDSS alerts are meaningless. If clinicians feel overwhelmed by the number of alerts they receive, they tend to ignore alerts. Furthermore, if clinicians feel that the alert is not critical enough or is completely wrong, they may become distrustful and decide not to act.
A clinician recently gave me the example of an 18-year-old athlete who saw a sepsis alert in the emergency room with a broken leg. His elevated heart rate triggered a sepsis alarm, which could also be characterized by an elevated heart rate, although sepsis was highly unlikely in his clinical situation. Knowing that this happens frequently, providers may ignore other warnings, as adults do when boys often call “wolves.”
Get more context with CDS Hooks
FHIR-based APIs help to connect systems and data from various sources such as Remote Patient Monitoring (RPM), Continuous Glucose Monitoring (CGM) and Patient Reported Results (PRO) solutions into one integrated application and EHR user experience. This standardization and interoperability allows decision support tools to ingest data beyond native EHR data in driving clinical insights and actions. Using CDS Hooks, these insights can be delivered directly in the EHR workflow.
The tool is finally getting commercial support from leading EHR vendors, which could encourage FHIR application developers to build narrower, more specific and context-sensitive rules — broken down by clinical site or user — to better aid CDSS Guidance on the most appropriate action. CDS Hooks envisions several forms that CDS hints (called CDS Hooks Cards) can take – information, advice or links to smart apps.
For example, a CDS card can identify a diabetic patient who has recently been admitted to the hospital and has displayed high blood sugar readings more than 10% of the time using a continuous glucose monitor. This card will alert the patient’s primary care practice or endocrinologist about this relevant insight (information card).
Alternatively, the card could go beyond providing information, allowing clinicians to place orders or text patients directly (suggestions). If clinicians wish to see more information and trends in CGM data, the card allows them to launch the FHIR app where they can explore the data (Smart App Link). The key here is to use all available data, put it in context, and alert appropriate clinicians involved in patient care to proactively avoid additional hospitalizations or other complications and achieve optimal outcomes.
CDS Hooks are no longer purely academic and theoretical – today’s leading EHRs are supporting the use of CDS Hooks. Adding CDS Hooks to the technology portfolio will simplify clinical workflows, especially as data sources and volumes continue to grow rapidly. By breaking down data silos and enabling more specific, contextual, and actionable decision support rules, CDS Hooks can provide better insights that help clinicians understand the next best step in patient care, while increasing the efficiency of clinical practice.
Photo: Natali_Mis, Getty Images
