Larry W. Holder, MD, FACP, FHM

Clinical decision support (CDS) can be defined very broadly as “a process for enhancing health-related decisions and actions with pertinent, organized clinical knowledge and patient information to improve health and healthcare delivery.” However, it's important to remember that simply deploying CDS does not automatically equate to performance improvement (PI), said Jerome Osheroff, MD, during a Wednesday morning session at HM12.

Dr. Osheroff is a leader in CDS and a key editor of the new HIMSS publication "Improving Outcomes with CDS: An Implementer's Guide." SHM co-sponsored the publication, and hospitalist Kendall Rogers was an editor.

Dr. Osheroff advised hospitalists to keep in mind the five "rights" of CDS: the right information, to the right people, in the right intervention formats, through the right channels, and at the right points in workflow. He also stressed the importance of workflow analysis, solid governance and management, and strategic plan development when initiating a hospital-based CDS program.

He finished the discussion by stressing the importance of collaboration, and described the "CDS/PI Collaborative," a multi-stakeholder national movement bringing CDS tools to caregivers and healthcare organizations.

"The screws are getting tighter and tighter" in healthcare, he said, and CDS collaboration needs to act as the screwdriver. In a show of hands during the session, the majority of attendees would participate in this approach, especially with SHM support.

Takeaways

• Apply the "CDS Five Rights" when implementing the CDS process.
• CDS deployment does not equate to performance improvement.
• The CDS/PI Collaborative can provide tools to healthcare organizations.
• Consider the Zen saying: A poor farmer produces weeds, a good farmer produces crops, a wise farmer produces soil.

Clinical decision support (CDS) can be defined very broadly as “a process for enhancing health-related decisions and actions with pertinent, organized clinical knowledge and patient information to improve health and healthcare delivery.” However, it's important to remember that simply deploying CDS does not automatically equate to performance improvement (PI), said Jerome Osheroff, MD, during a Wednesday morning session at HM12.

Dr. Osheroff is a leader in CDS and a key editor of the new HIMSS publication "Improving Outcomes with CDS: An Implementer's Guide." SHM co-sponsored the publication, and hospitalist Kendall Rogers was an editor.

Dr. Osheroff advised hospitalists to keep in mind the five "rights" of CDS: the right information, to the right people, in the right intervention formats, through the right channels, and at the right points in workflow. He also stressed the importance of workflow analysis, solid governance and management, and strategic plan development when initiating a hospital-based CDS program.

He finished the discussion by stressing the importance of collaboration, and described the "CDS/PI Collaborative," a multi-stakeholder national movement bringing CDS tools to caregivers and healthcare organizations.

"The screws are getting tighter and tighter" in healthcare, he said, and CDS collaboration needs to act as the screwdriver. In a show of hands during the session, the majority of attendees would participate in this approach, especially with SHM support.

Takeaways

• Apply the "CDS Five Rights" when implementing the CDS process.
• CDS deployment does not equate to performance improvement.
• The CDS/PI Collaborative can provide tools to healthcare organizations.
• Consider the Zen saying: A poor farmer produces weeds, a good farmer produces crops, a wise farmer produces soil.

Clinical decision support (CDS) can be defined very broadly as “a process for enhancing health-related decisions and actions with pertinent, organized clinical knowledge and patient information to improve health and healthcare delivery.” However, it's important to remember that simply deploying CDS does not automatically equate to performance improvement (PI), said Jerome Osheroff, MD, during a Wednesday morning session at HM12.

Dr. Osheroff is a leader in CDS and a key editor of the new HIMSS publication "Improving Outcomes with CDS: An Implementer's Guide." SHM co-sponsored the publication, and hospitalist Kendall Rogers was an editor.

Dr. Osheroff advised hospitalists to keep in mind the five "rights" of CDS: the right information, to the right people, in the right intervention formats, through the right channels, and at the right points in workflow. He also stressed the importance of workflow analysis, solid governance and management, and strategic plan development when initiating a hospital-based CDS program.

He finished the discussion by stressing the importance of collaboration, and described the "CDS/PI Collaborative," a multi-stakeholder national movement bringing CDS tools to caregivers and healthcare organizations.

"The screws are getting tighter and tighter" in healthcare, he said, and CDS collaboration needs to act as the screwdriver. In a show of hands during the session, the majority of attendees would participate in this approach, especially with SHM support.

Takeaways

• Apply the "CDS Five Rights" when implementing the CDS process.
• CDS deployment does not equate to performance improvement.
• The CDS/PI Collaborative can provide tools to healthcare organizations.
• Consider the Zen saying: A poor farmer produces weeds, a good farmer produces crops, a wise farmer produces soil.

The key word in the title of this Tuesday session at HM12 was "change." In 50 years, healthcare expenditures will consume 50% of the U.S. national GDP. Change in hospital medicine has to happen to accommodate this.

Robert Bessler, a former economics graduate, kept the talk interesting and simple enough even for a non-financial physician like myself. As everyone knows, the cost of health care is rapidly rising and will likely be unsustainable. Bressler described hospital medicine economic management as being made up of "three legs of a stool": These legs are the cost of healthcare, the quality of healthcare, and access to healthcare.

Two important occurrences that complicate quality are the aging baby boomers and the obesity epidemic hitting Americans. Access represents the second leg of the "stool," and it's extremely shaky. The demand for care will eventually exceed the professionals ability to provide it, as more patients become insured and some hospitals go bankrupt (an estimated 15% will do so in the next eight years), said Bressler.

Hospitalists will play a major role in the future in the financial health of medical institutions, the third leg of the stool. Bessler called hospitalists the "pit crew leaders" and our turf encompasses "accountable" acute-care episodes.

Takeaways

• The cost of healthcare is unsustainable.
• Quality will play a key role in decreasing costs.
• Access to healthcare will be constrained.
• Accountable acute-care episodes are on hospitalist "turf."

The key word in the title of this Tuesday session at HM12 was "change." In 50 years, healthcare expenditures will consume 50% of the U.S. national GDP. Change in hospital medicine has to happen to accommodate this.

Robert Bessler, a former economics graduate, kept the talk interesting and simple enough even for a non-financial physician like myself. As everyone knows, the cost of health care is rapidly rising and will likely be unsustainable. Bressler described hospital medicine economic management as being made up of "three legs of a stool": These legs are the cost of healthcare, the quality of healthcare, and access to healthcare.

Two important occurrences that complicate quality are the aging baby boomers and the obesity epidemic hitting Americans. Access represents the second leg of the "stool," and it's extremely shaky. The demand for care will eventually exceed the professionals ability to provide it, as more patients become insured and some hospitals go bankrupt (an estimated 15% will do so in the next eight years), said Bressler.

Hospitalists will play a major role in the future in the financial health of medical institutions, the third leg of the stool. Bessler called hospitalists the "pit crew leaders" and our turf encompasses "accountable" acute-care episodes.

Takeaways

• The cost of healthcare is unsustainable.
• Quality will play a key role in decreasing costs.
• Access to healthcare will be constrained.
• Accountable acute-care episodes are on hospitalist "turf."

The key word in the title of this Tuesday session at HM12 was "change." In 50 years, healthcare expenditures will consume 50% of the U.S. national GDP. Change in hospital medicine has to happen to accommodate this.

Robert Bessler, a former economics graduate, kept the talk interesting and simple enough even for a non-financial physician like myself. As everyone knows, the cost of health care is rapidly rising and will likely be unsustainable. Bressler described hospital medicine economic management as being made up of "three legs of a stool": These legs are the cost of healthcare, the quality of healthcare, and access to healthcare.

Two important occurrences that complicate quality are the aging baby boomers and the obesity epidemic hitting Americans. Access represents the second leg of the "stool," and it's extremely shaky. The demand for care will eventually exceed the professionals ability to provide it, as more patients become insured and some hospitals go bankrupt (an estimated 15% will do so in the next eight years), said Bressler.

Hospitalists will play a major role in the future in the financial health of medical institutions, the third leg of the stool. Bessler called hospitalists the "pit crew leaders" and our turf encompasses "accountable" acute-care episodes.

Takeaways

• The cost of healthcare is unsustainable.
• Quality will play a key role in decreasing costs.
• Access to healthcare will be constrained.
• Accountable acute-care episodes are on hospitalist "turf."

The key word in the title is change. The most frightening number that proves change has to happen is that in 50 years healthcare expenditures will consume 50% of our nation's GDP. No way that can be sustained.

The three legs of the stool to manage HM economics include 1) cost of healthcare, 2) quality of healthcare, and 3) access to healthcare.

Dr. Robert Bessler, a former economics graduate, kept the talk interesting and simple enough even for a non-financial physician like myself. As everyone knows the cost of healthcare is rapidly rising and thus unsustainable, measures to improve quality and improve patient safety form one of the legs of the healthcare economics stool.

Two important occurrences that complicate quality are the aging baby boomers and the obesity epidemic hitting Americans. Access represents the second leg which is extremely shaky. In the near future, demand will exceed the number of professionals to provide care, as more patients become insured. Some hospitals will go bankrupt; estimates are 15% by 2020.

The last leg is cost, an area in which hospitalists will have a major role in the future, as they become more a part of the financial health of medical institutions. Dr. Bessler called hospitalists the "pit crew leaders," and said our turf is the "accountable," acute-care episode.

Key Takeaways:

• Cost of healthcare is unsustainable.
• Quality will provide key role in decreasing costs.
• Access to healthcare will be constrained.
• Accountable acute care episodes is HM's turf.

Dr. Holder is medical director of hospitalist services and chief medical information officer, Decatur Memorial Hospital, Decatur, Ill. He is also chairman of the SHM IT Quality Committee.

The key word in the title is change. The most frightening number that proves change has to happen is that in 50 years healthcare expenditures will consume 50% of our nation's GDP. No way that can be sustained.

The three legs of the stool to manage HM economics include 1) cost of healthcare, 2) quality of healthcare, and 3) access to healthcare.

Dr. Robert Bessler, a former economics graduate, kept the talk interesting and simple enough even for a non-financial physician like myself. As everyone knows the cost of healthcare is rapidly rising and thus unsustainable, measures to improve quality and improve patient safety form one of the legs of the healthcare economics stool.

Two important occurrences that complicate quality are the aging baby boomers and the obesity epidemic hitting Americans. Access represents the second leg which is extremely shaky. In the near future, demand will exceed the number of professionals to provide care, as more patients become insured. Some hospitals will go bankrupt; estimates are 15% by 2020.

The last leg is cost, an area in which hospitalists will have a major role in the future, as they become more a part of the financial health of medical institutions. Dr. Bessler called hospitalists the "pit crew leaders," and said our turf is the "accountable," acute-care episode.

Key Takeaways:

• Cost of healthcare is unsustainable.
• Quality will provide key role in decreasing costs.
• Access to healthcare will be constrained.
• Accountable acute care episodes is HM's turf.

Dr. Holder is medical director of hospitalist services and chief medical information officer, Decatur Memorial Hospital, Decatur, Ill. He is also chairman of the SHM IT Quality Committee.

The key word in the title is change. The most frightening number that proves change has to happen is that in 50 years healthcare expenditures will consume 50% of our nation's GDP. No way that can be sustained.

The three legs of the stool to manage HM economics include 1) cost of healthcare, 2) quality of healthcare, and 3) access to healthcare.

Dr. Robert Bessler, a former economics graduate, kept the talk interesting and simple enough even for a non-financial physician like myself. As everyone knows the cost of healthcare is rapidly rising and thus unsustainable, measures to improve quality and improve patient safety form one of the legs of the healthcare economics stool.

Two important occurrences that complicate quality are the aging baby boomers and the obesity epidemic hitting Americans. Access represents the second leg which is extremely shaky. In the near future, demand will exceed the number of professionals to provide care, as more patients become insured. Some hospitals will go bankrupt; estimates are 15% by 2020.

The last leg is cost, an area in which hospitalists will have a major role in the future, as they become more a part of the financial health of medical institutions. Dr. Bessler called hospitalists the "pit crew leaders," and said our turf is the "accountable," acute-care episode.

Key Takeaways:

• Cost of healthcare is unsustainable.
• Quality will provide key role in decreasing costs.
• Access to healthcare will be constrained.
• Accountable acute care episodes is HM's turf.

Dr. Holder is medical director of hospitalist services and chief medical information officer, Decatur Memorial Hospital, Decatur, Ill. He is also chairman of the SHM IT Quality Committee.

The topic was of strong interest, as demonstrated by the standing-room-only group of hospitalists attending Monday afternoon's presentation at HM12 in San Diego on the brand new antithrombic therapy from ACCP. I doubt giving away a new IPAD 3 would have brought a bigger audience. However, no one left disappointed, leaving with valuable new information which could be used at the bedside.

The excellent, evidence-based rapid fire presentation by Catherine Curley took us as a tour guide through key aspects of the new guidelines. The methodology improvements were extremely important. She used the more-controversial topics as examples: treatment of submassive PE, use of catheter directed thrombolysis in patients with acute DVT, and the recommended VTE prophylaxis. She even threw in some anatomy lessons for us clinicians.

Key Takeaways:

1. Major innovations in the methodology in the AT9. Focus on the absolute effects allow the provider to weight the benefit and risk of therapy easily, rigorous conflict of interests review of the editors, re-analysis of many older studies, and simplified recommendations with emphasis on summary of finding tables as opposed to texts
.
2. A strong focus on patient-centered outcomes. This is the first major guideline I have seen that recommends specifically focusing on the patients preferences.

Dr. Holder is medical director of hospitalist services and chief medical information officer at Decatur (Ill.) Memorial Hospital.

The topic was of strong interest, as demonstrated by the standing-room-only group of hospitalists attending Monday afternoon's presentation at HM12 in San Diego on the brand new antithrombic therapy from ACCP. I doubt giving away a new IPAD 3 would have brought a bigger audience. However, no one left disappointed, leaving with valuable new information which could be used at the bedside.

The excellent, evidence-based rapid fire presentation by Catherine Curley took us as a tour guide through key aspects of the new guidelines. The methodology improvements were extremely important. She used the more-controversial topics as examples: treatment of submassive PE, use of catheter directed thrombolysis in patients with acute DVT, and the recommended VTE prophylaxis. She even threw in some anatomy lessons for us clinicians.

Key Takeaways:

1. Major innovations in the methodology in the AT9. Focus on the absolute effects allow the provider to weight the benefit and risk of therapy easily, rigorous conflict of interests review of the editors, re-analysis of many older studies, and simplified recommendations with emphasis on summary of finding tables as opposed to texts
.
2. A strong focus on patient-centered outcomes. This is the first major guideline I have seen that recommends specifically focusing on the patients preferences.

Dr. Holder is medical director of hospitalist services and chief medical information officer at Decatur (Ill.) Memorial Hospital.

The topic was of strong interest, as demonstrated by the standing-room-only group of hospitalists attending Monday afternoon's presentation at HM12 in San Diego on the brand new antithrombic therapy from ACCP. I doubt giving away a new IPAD 3 would have brought a bigger audience. However, no one left disappointed, leaving with valuable new information which could be used at the bedside.

The excellent, evidence-based rapid fire presentation by Catherine Curley took us as a tour guide through key aspects of the new guidelines. The methodology improvements were extremely important. She used the more-controversial topics as examples: treatment of submassive PE, use of catheter directed thrombolysis in patients with acute DVT, and the recommended VTE prophylaxis. She even threw in some anatomy lessons for us clinicians.

Key Takeaways:

1. Major innovations in the methodology in the AT9. Focus on the absolute effects allow the provider to weight the benefit and risk of therapy easily, rigorous conflict of interests review of the editors, re-analysis of many older studies, and simplified recommendations with emphasis on summary of finding tables as opposed to texts
.
2. A strong focus on patient-centered outcomes. This is the first major guideline I have seen that recommends specifically focusing on the patients preferences.

Dr. Holder is medical director of hospitalist services and chief medical information officer at Decatur (Ill.) Memorial Hospital.

Patrick Conway, MD, MSc, chief medical officer of CMS and director of the Office of Clinical Standards and Quality, stated he has taken a position that pays less, has more hours, and tends to upset lots of people. But at the same time, its the most rewarding and most difficult job he has done. And so began an information-filled discussion on CMS policies.

Fortunately, he is one of SHM's own who has the core hospitalist value of quality and patient-centeredness. He also is in a position of power in the government.

An obvious focus of CMS, Dr. Conway explained, is to push the U.S. healthcare system toward a patient-centered outcome measures. Throughout the various projects (value-based purchasing, bundled-payment projects, Save a Million Heart program, readmission reduction) is the goal of improved patient-centered care. In addition the concepts of "better care, better health, and lower costs" represents the cornerstones of this historic time in healthcare.

Key Takeaway: A call to collective action.

What can you do:

1. Partner with your hospital administration and quality improvement teams;
2. Understand your hospitals performance data;
3. Take a physician leadership role; and
4. Create a collaboration with your community partners.

Patrick Conway, MD, MSc, chief medical officer of CMS and director of the Office of Clinical Standards and Quality, stated he has taken a position that pays less, has more hours, and tends to upset lots of people. But at the same time, its the most rewarding and most difficult job he has done. And so began an information-filled discussion on CMS policies.

Fortunately, he is one of SHM's own who has the core hospitalist value of quality and patient-centeredness. He also is in a position of power in the government.

An obvious focus of CMS, Dr. Conway explained, is to push the U.S. healthcare system toward a patient-centered outcome measures. Throughout the various projects (value-based purchasing, bundled-payment projects, Save a Million Heart program, readmission reduction) is the goal of improved patient-centered care. In addition the concepts of "better care, better health, and lower costs" represents the cornerstones of this historic time in healthcare.

Key Takeaway: A call to collective action.

What can you do:

1. Partner with your hospital administration and quality improvement teams;
2. Understand your hospitals performance data;
3. Take a physician leadership role; and
4. Create a collaboration with your community partners.

Patrick Conway, MD, MSc, chief medical officer of CMS and director of the Office of Clinical Standards and Quality, stated he has taken a position that pays less, has more hours, and tends to upset lots of people. But at the same time, its the most rewarding and most difficult job he has done. And so began an information-filled discussion on CMS policies.

Fortunately, he is one of SHM's own who has the core hospitalist value of quality and patient-centeredness. He also is in a position of power in the government.

An obvious focus of CMS, Dr. Conway explained, is to push the U.S. healthcare system toward a patient-centered outcome measures. Throughout the various projects (value-based purchasing, bundled-payment projects, Save a Million Heart program, readmission reduction) is the goal of improved patient-centered care. In addition the concepts of "better care, better health, and lower costs" represents the cornerstones of this historic time in healthcare.

Key Takeaway: A call to collective action.

What can you do:

1. Partner with your hospital administration and quality improvement teams;
2. Understand your hospitals performance data;
3. Take a physician leadership role; and
4. Create a collaboration with your community partners.

The geeks of the Society of Hospital Medicine met to plan out the coming year during the SHM IT Quality Subcommittee Meeting, held Sunday at HM12. Actually, the committee is far from the "The Big Bang Theory" caricature. During the introduction we meet members who snowboard, ski, sail, cycle, play tennis, climb mountains, and even collect German cars. After introductions, the majority of the meeting focused on goals for the year.

The main point of discussion surrounded the concept of Clinical Decision Support (CDS). The committee was very lucky to have Jerry Osheroff, one of the key editors of the new HIMSS publication Improving Outcomes with CDS: An Implementer's Guide. The SHM was a co-sponsor of the publication, and the society's own Kendall Rogers was an editor. Osheroff reviewed the concept of CDS, and included a discussion of the CDS/PI Collaborative, a program he leads. The committee elected to extensively study this approach as a way to bring health IT and quality back together. Brian Donavon best summed up member impressions when he said, "We have lost control of IT."

Bottom Line

• Within a few weeks, the committee will develop goals for the coming year.

• The committee is giving serious consideration to incorporating CDS into the HQPS initiatives, and bringing the concept to the SHM membership at large.

Dr. Holder is medical director of hospitalist services and chief medical information officer, Decatur Memorial Hospital, Decatur, Ill. He is also chairman of the SHM IT Quality Committee.

The geeks of the Society of Hospital Medicine met to plan out the coming year during the SHM IT Quality Subcommittee Meeting, held Sunday at HM12. Actually, the committee is far from the "The Big Bang Theory" caricature. During the introduction we meet members who snowboard, ski, sail, cycle, play tennis, climb mountains, and even collect German cars. After introductions, the majority of the meeting focused on goals for the year.

The main point of discussion surrounded the concept of Clinical Decision Support (CDS). The committee was very lucky to have Jerry Osheroff, one of the key editors of the new HIMSS publication Improving Outcomes with CDS: An Implementer's Guide. The SHM was a co-sponsor of the publication, and the society's own Kendall Rogers was an editor. Osheroff reviewed the concept of CDS, and included a discussion of the CDS/PI Collaborative, a program he leads. The committee elected to extensively study this approach as a way to bring health IT and quality back together. Brian Donavon best summed up member impressions when he said, "We have lost control of IT."

Bottom Line

• Within a few weeks, the committee will develop goals for the coming year.

• The committee is giving serious consideration to incorporating CDS into the HQPS initiatives, and bringing the concept to the SHM membership at large.

Dr. Holder is medical director of hospitalist services and chief medical information officer, Decatur Memorial Hospital, Decatur, Ill. He is also chairman of the SHM IT Quality Committee.

The geeks of the Society of Hospital Medicine met to plan out the coming year during the SHM IT Quality Subcommittee Meeting, held Sunday at HM12. Actually, the committee is far from the "The Big Bang Theory" caricature. During the introduction we meet members who snowboard, ski, sail, cycle, play tennis, climb mountains, and even collect German cars. After introductions, the majority of the meeting focused on goals for the year.

The main point of discussion surrounded the concept of Clinical Decision Support (CDS). The committee was very lucky to have Jerry Osheroff, one of the key editors of the new HIMSS publication Improving Outcomes with CDS: An Implementer's Guide. The SHM was a co-sponsor of the publication, and the society's own Kendall Rogers was an editor. Osheroff reviewed the concept of CDS, and included a discussion of the CDS/PI Collaborative, a program he leads. The committee elected to extensively study this approach as a way to bring health IT and quality back together. Brian Donavon best summed up member impressions when he said, "We have lost control of IT."

Bottom Line

• Within a few weeks, the committee will develop goals for the coming year.

• The committee is giving serious consideration to incorporating CDS into the HQPS initiatives, and bringing the concept to the SHM membership at large.

Dr. Holder is medical director of hospitalist services and chief medical information officer, Decatur Memorial Hospital, Decatur, Ill. He is also chairman of the SHM IT Quality Committee.