Speaker: Rachel Gold, Ph.D., MPH
Assistant Investigator ,
Kaiser Permanente Center for Health Research
Integrated health care organizations such as Kaiser Permanente (Kaiser) have developed clinical decision support systems (CDSS) that harness EHR data to improve provider adherence to guideline-based prescribing. For example, Kaiser's diabetes quality improvement intervention, the 'ALL Initiative,' uses EHR-based CDSS tools to improve rates of guideline-based cardio-protective prescribing. To assess whether this effective intervention could be adapted for use in CHCs, we conducted a 'translational' randomized trial involving11 CHCs in Portland, OR. We adapted Kaiser's intervention elements for the CHC context, implemented the adapted CDSS tools in the study CHCs, and assessed how the tools impacted rates of guideline-based prescribing. We found that we needed to substantially adapt the EHR-based tools to provide the CHCs with functions equivalent to Kaiser's; we also identified and addressed a number of challenges to integrating the tools into the CHCs' workflows. Despite these challenges, implementing the 'ALL Initiative' CDSS tools was associated with significant improvements in care quality. Our results illustrate the challenges involved in using EHR-based tools to support practice change and quality improvement efforts in CHCs.