Vol1 #3 - Clinical Decision Support & Reduction of Medication Errors [P&T, IT, LDR]
Clinical Decision Support (CDS) is defined broadly as a clinical system, application or process that helps health professionals make clinical decisions to enhance patient care. Clinical Decision Support Systems can assist with medication safety and related quality of care and cost savings issues . It has in fact been "shown to reduce adverse drug events (ADEs) by 55 percent, medication-related errors by 88 percent and costs by millions of dollars per year within a single hospital." The Medicare Modernization act of 2003 mandated the Institute of Medicine (IOM) to “carry out a comprehensive study1 of drug safety and quality . The study was mandated by Congress based on results of an earlier study2 by the IOM in 1999 reporting that “more than 7,000 people in the United States die annually from medication errors”. The objectives of the 2003 study include identification of strategies to achieve drug safety goals and to implement a process to reduce medication errors. The report brief from the IOM in July ,2006 on “Preventing Medication Errors “ identified continuing high rates of medication errors and suggested methods to reduce them
One method to use in preventing medication errors is to make greater use of information technologies . Clinical decision support uses the best available medical information resources to guide treatment interventions. This leads us to the consideration of how to begin to incorporate clinical decision support into medication management . The 2008 National Patient Safety Goals promulgated by JCAHO focus on specific areas for improvement in patient safety. NPSG 3 ,Improve the safety of using medications ,is included in those standards that impact behavioral health providers . Using the best drug knowledge available provided through easily accessed technology can improve medication management outcomes . As you think about how to utilize an Electronic Medical Record , also consider how to improve the staff –computer interface and how to create internet-accessible clinical decision support repositories . The challenges ahead are to move into electronic support for clinical decision making are many . It’s an exciting time for those of us working in the behavioral health arena.
TIP: Get ahead of the curve. LDR, P&T and IT should download and read this 2-page fact sheet. Clinical Decision Support for National Healthcare Quality Improvement: Promises, Challenges, and Solutions (PDF)
Identifying and Preventing Medication Errors {HTML}
The 2003 report from the members of President’s New Freedom Commission on Mental Health is entitled “Achieving the Promise: Transforming Mental Health in America.” Goal 6 in the report addresses the use of technology as a tool to support the delivery of “the best care “by the provider and to empower the consumer and families to participate actively in the management of their health care. One recommendation related to the implementation of Goal 6 is to “develop and implement integrated electronic health record and personal health information systems “to strengthen the exchange of health information electronically. A 2006 report from the National Association of State Mental Health Program Directors Research Institute, Inc (NRI) found that of the 47 states submitting data; only 22 states were implementing electronic medical records in their state psychiatric hospitals. If you are in the 22 or would like to move in that direction you might want to check that listing ( State EMR Profile ). Pearl: See below
Those of us working in the mental health system of care have long advocated for increased and improved coordination of care with the primary care system for the patients and clients who have co-morbid physical disorders. Now we learn that Google and Microsoft are developing personal health record management services. In a 2-20-08 article, Cleveland Clinic describes collaboration with Google “to enhance patients’ healthcare experience “through a secure exchange of health information. (Cleveland Clinic Collaborates With Google to Enhance Patients’ Healthcare Experience ) This health information exchange will allow patients to manage their health care information in a proactive manner by putting “patients in charge of their own health information. However, a key question is Will the patient receiving services in a state psychiatric be able to manage their own health care information or have an opportunity to share pertinent data, i.e., medication regime, allergies or known conditions in order to be able to participate in the management of their health care while maintaining privacy and confidentiality? We may also want to ask how we might take advantage of such developments (e.g., additional sources of health information) and what roles our staff (e.g., IT, SW) might then need to play?
Vol1 #1 - Case Management/Targeted Case Management
The Targeted Case Management, Interim Final Rule is due to go into effect March 3, 2008. There are many concerns about the language in the Interim Rule and the impact on service delivery for Medicaid recipients. Case management is defined in the publication, DRA 2006, Section 6052. Reforms of Case Management and Targeted Case Management, (PDF ). The changes in definition are expected to save more than a billion dollars over the next 5 years. Unfortunately, this savings seem to be accomplished by limiting access to case management for certain Medicare beneficiaries. If the interpretation of the new definition is correct and the case manager may no longer function as a “gate keeper”, the hospital process of coordination of care for discharge planning may be impacted. The United States Psychiatric Rehabilitation Association (USPRA) has formulated a Response to Proposed CMS Regs (PDF) that further explores that impact.
Section 440.1169 of the DRA discusses case management and /or Targeted Case Management (CM/TCM) provided to individuals transitioning from institutions into the community. As described in the summary of the the National Council for Community Behavioral Healthcare (NCCBH) Town Hall Meeting on December 7, 2007 , the conditions for receiving CM/TCM laid out by CMS seem to lose sight of the benefit of coordination of care at discharge from an institution.
The most recent Action Alert from the NCCBH on February 14th lets us know that there are still efforts underway to postpone implementation and place a moratorium on the case management rule until April 1, 2009. However, this issue is worth keeping an eye on. More to come. – by Miriam Kile, R.N., M.S.
See also:
• National Council detailed summary of the interim regulations
• CMS’ fact sheet on the proposed regulations
