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being flagged and exactly where the interaction is. In
this case, the flag from the software prevented that
patient from having another bad reaction."
At Mercy Health System, DSS has "prevented a
lot of near-misses," Garbarino says. "There are tons
of case studies showing how the software definitely
makes a di erence in patient care. When used cor-
rectly, DSS can help the clinician reach best practice
standards for patient safety."
Implementing a DSS Program
To start improving patient care through the use
of decision support software, begin by analyzing the
system your EMR vendor provides out of the box,
Garbarino says. "Clinical decision support is often
built into an EMR vendor's program, but it may not
be too robust," he says.
While almost all decision support software pro-
grams include allergy checking, many also include
various other features, such as displaying informa-
tion about how drugs interact with other drugs,
clinical drug content and
patient discharge infor-
mation. Some programs
provide links to literature
that supports their recom-
mendations, or produce
reports that recommend
cultures or renal dosing.
If your basic DSS system
imbedded in your EMR
solution doesn't include
all the components you're
looking for, consider seeking another system from
a separate vendor or an upgraded system from your
EMR provider. "First, see what your vendor o ers
out of the box, and then customize it to meet patient
needs at your facilities," Garbarino advises. "If the
system you have doesn't provide the solution you
need, you may need to go to a third party. The next
step is to obtain software that will dive deeper than
your basic program."
Regardless of which program you use, each facil-
ity can determine what types of information will be
displayed to physicians and others through its DSS
system. For instance, at Mercy Health System, the
pharmacology department has set up its DSS program
to provide physicians with research support anytime
it flags a choice of medication. "It might say, 'Consider
this drug,' and include a link. Or it might say, 'The
FDA says in this clinical situation, this drug is the best
one to use,' " Garbarino says. "You can program the
decision support software to do that automatically."
Mercy Health incorporates a blue ribbon system
to show best practices for di erent situations. The
drug that research shows to be the best practice
drug in a particular clinical situation will be tagged
with a blue ribbon in the system, which helps the
facility to achieve the standardization of care that is
an important component of health-care reform.
As with any program that aims to improve patient
care and patient outcomes, your DSS system will only
be successful if it wins the approval of and participa-
tion from the clinicians who must use the system.
The main drawback to achieving buy-in from these
important stakeholders is "over-flagging," Garbarino
says. "Pharmacists are used to it, but you don't want
to over-flag the physicians. If they are over-flagged,
they may ignore an important flag."
At Mercy Health, the key to achieving physicians'
approval for the program is to avoid making them
feel as though they are being told how to practice
medicine; instead, they should see the program as
a vital tool that can help them keep track of con-
stant changes in government regulations, medical
research and patient conditions.
"Be honest with your physicians," Garbarino
advises. "Tell them, 'We're flagging this because we
want to improve patient safety.' But encourage them
to provide input into the program. Ask them to let
your department know if they are getting flags they
don't want to see. You can set the system's flagging
level based on what you want them to see."
When physicians understand the necessity of
using the DSS system and how it can help them
perform better, and when they feel that their input
is a valued part of the solution, they are more likely
to cooperate. And their cooperation is vital to meet-
ing the goals of patient safety and standardization
that DSS systems set out to reach. •
Launching a DSS
program takes a
of time and training,
according to Stephanie
of clinical pharmacy
services. For the
systems to be success-
ful, clinicians have to
learn the system, help
determine which flags
to set, track the alerts,
validate the informa-
tion and update the
content. "Is it worth
it? Yes," Thompson
says. "But it is often
overwhelming for all
when a system adopts
a DSS tool. Patience is
key. Like all technol-
ogy, these tools are
definitely valued more
as users become more
familiar with their
At Mercy Health System, DSS has
"prevented a lot of near-misses.
When used correctly, the software can
help the clinician reach best practice
standards for patient safety."
-- JOSEPH GARBARINO, PHARMD, CLINICAL PHARMACY INFORMATICS
SPECIALIST, MERCY HEALTH SYSTEM IN CONSHOHOCKEN, PA.
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