With all the water cooler talk about electronic health record systems, it's easy to overlook the other strides being made in electronic health technology. One area of particular promise is Clinical Decision Support software, which aims to reduce medical errors and enhance the quality of patient care. A leading proponent of clinical decision support systems is TheraDoc, Inc., of Salt Lake City, Utah, whose CDS system is installed in over 200 hospitals nationally.

TheraDoc's Expert Platform System is touted as a major contributor to reversing the trend of hospital borne infection and improving pediatric home care for children with asthma. Clinical Decision Support software creates a kind of electronic library of best practices to inform physician decision making. TheraDoc compiles all of the research that usually gathers dust on desks, uses field experts to review the literature, and tease out the important findings. This information is then transferred to an electronic library that doctors can access in real-time as they diagnose patients. 

Armed with up-to-date information on patient treatments as they review patient data, doctors get an efficient overview of a patient’s condition. The extra information provided by the CDS enables a physician to consider more evidence, which hopefully leads to superior care.

An additional benefit of clinical decision support systems is that they can help flag adverse drug reactions and disease markers, therefore enhancing patient safety and quality of care. TheraDoc's knowledge modules cover topics such as infection control, clinical alerts, antibiotics, and adverse drug events.

CDS vs. EHR

Electronic health records are still the big kahuna, and CDS systems aren't a true substitute. But clinical decision support system are another layer of technology that beef up hospital information systems and potentially make existing EHR systems even more efficient.

The Veterans Administration is a case in point. The VA installed TheraDoc's CDS in 2007, attaching it to its mega-monster VISTA system in an effort to streamline data onto one screen for physicians. 

TheraDoc says that its CDS can work with a hospital’s existing legacy system—and the fact it worked with the VA is a powerful case study. But a comprehensive EHR system is not a prerequisite for a hospital system to implement TheraDoc's software. The product is interoperable, merging and standardizing multiple sources of data and then spitting it out to physicians in an easy-to-use format. The doc gets information in one vehicle rather than several. 

Scott Walker, TheraDoc's vice president of strategic development, argues that EHR products do not offer content as sophisticated as TheraDoc's software (and they have a patent to keep it that way…). A comprehensive EHR tends to include multiple functionalities, with decision support being just one piece. TheraDoc focuses solely on real-time decision support for physicians. The benefits are clear:  24/7 monitoring of patients, infection control, adverse drug event control… but does it work in practice?

Using Technology to Battle Infection and Human Imperfection

Infections in hospitals are a serious problem. As a patient, the last thing you want is to get sick in a hospital bed when you were admitted for a different illness or injury. Spotlighted by the Centers for Disease Control in 2000, hospital infection emerged a priority for hospitals as the public learned of their frequency and sometimes fatal results.

One dangerous type of infection is central line-associated bloodstream infections, known in short as CLASBI. These infections can add up to $40,000 to the cost of hospitalization, says an epidemiology and infection expert at the Hospital of the University of Pennsylvania. That is why UPenn installed and included TheraDoc in their eradication plan of CLASBI. The results were a 90 percent drop over the past three years in the dangerous bloodstream infection. This translates into significant cost savings for the hospital, and even more importantly, the saving of patients' lives.

TheraDoc's system helped personnel put in place an electronic infection surveillance plan that paired checklists for IV insertion procedures (the human side) with electronic identification of real-time problems such as patient infections (the software side).

UPenn is not the only Theradoc cheerleader. Florida’s Joe DiMaggio Children’s Hospital brags of a 90 percent compliance rate with asthma home plans. TheraDoc software flags patients with episodes that may be related to asthma but do not have a primary diagnosis of asthma. Once these patients are identified, preventative home plans are developed. Home plans for these patients are vital to long term health and may reduce a patient’s readmission and visit rates (which are among the highest for pediatric patients).

The future of CDS… what about the role of government?

The recent economic stimulus package dumped some serious cash into EHR expansion, but none was directly targeted for clinical decision support. Yet CDS software companies are poised to benefit from the infusion of capital into hospital and physician office technology in general. As more hospitals and physicians engage on a technological platform, they may be inclined to adopt CDS software as they increasingly pursue goals of organizational efficiency and patient care quality. 

The Obama Administration's rhetorical backing of evidenced-based medicine would appear to be a further boon for the philosophy of decision support. The catch, of course, will be how much the government gets involved in guiding the evidence-based medicine movement.

For some hospital systems, CDS may be a more cost-effective solution to generating efficiency than EHR investment. On average, according to Walker, TheraDoc costs $500-600,000 over 5 years for systems whereas EHR installation and maintenance may far exceed that cost. However, it remains to be seen whether the incentives introduced by government for EHR adoption will ultimately boost or deter adoption of more intense CDS products such as TheraDoc.

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