What You Need to Know About the 21st Century Cures Act Part 3:Maintaining a Proactive Clinical Workflow

In the previous two parts of this series, we discussed going beyond basic interoperability and electronic health record (EHR) adoption. In this post, we’ll dive into the importance of proactive clinical workflows.

Part of the 21st Century Cures Act discusses how proactive clinical workflows can help prevent substance use by identifying effective strategies and performing evaluations to achieve and sustain a client’s health more quickly. Addiction is not a standalone issue, and there are tools within a seamless clinical workflow that can help identify underlying issues.

In the world of clinical workflow, there is a huge paradigm shift happening. Everyone has a dashboard that looks backward in time, which only allows you to be reactive in your data. That’s so 2018. We are now shifting to a world where we’re moving from reactive dashboards to proactive real-time data. Clinicians don’t want to have to stop their current documentation, go to a different dashboard and then back again, especially when the data update is delayed. I’m talking about a new industry standard where real-time data is part of a clinician’s workflow. That means getting the right data at the right time.

Today, it is critical that part of that workflow should be proactive, clinical decision support – not a basic, reactive alert. Decision support should live in the workflow, so a clinician doesn’t have to exit out of what he or she is doing to find information. If there’s something I need to know while caring for an individual, I want it to tell me. I shouldn’t have to go searching for that piece of important information. Real-time analytics are not anything new, they’ve been used for drug-to-drug interactions for many years, however, we just want to use them in a new fashion.

Having access to real-time data inside a clinical workflow will provide improved compliance. For example, say a client has hypertension, which recently escalated with an outburst of anger. While doing a review of systems (ROS), the doctor asks about his or her drinking patterns. The individual says they have one glass of wine a day. Regular alcohol use can actually lead to hypertension and violence, but because the doctor doesn’t have real-time access to the information, he or she misses the connection.

In comparison, it’s easy for the right EHR to connect these dots. The EHR will ask the clinician if they would like to do a deeper assessment to better gauge dependence. Catching dependence or addiction at an early stage can mean a reduction of key symptoms; for example, substance use to non-problematic levels and improvement in general patient health. Spotting this connection through an EHR will not only improve compliance, but ultimately lead to reduced costs.

Real-time analytics can also measure outcomes in an accurate and effective manner, allowing clinicians to measure both the outcomes and the processes. It’s important for the clinician to be able to identify the underlying issue, not just the symptoms.

Going back the previous example, when providing similar care for other chronic diseases, screening is effective in preventing, reducing, treating and sustaining recovery from substance misuse and substance use disorders (SUDs). Measures that capture screening and intervention for SUDs have been endorsed by the National Quality Forum (NQF). Today there are three NQF-endorsed quality measures specific to addiction treatment, however, it’s important to note others are needed.

• Continuity of care
• Initiation and engagement measure
• Continuity of pharmacotherapy for opioid use disorder measure, and follow-up after substance use disorder-related emergency department visit measure

If you have a full case load, it’s hard to not get caught up in your day to day. By monitoring quality measures, you can make sure you’re reaching benchmarks and providing quality, safe care. We need to be on the front-end of the data so that we may be proactive in the care we provide. Make sure your EHR has the capability to help you go from reactive to proactive in informing clinicians, that way you can continue to provide the best care possible and enhance your workflow along the way.