Clinical Decision Support Systems Arrive

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FORWARD THINKERS IN CLINICAL LABORATORIES and anatomic pathology groups have always recognized the substantial, but as yet unharvested, potential that would accrue to the healthcare system were clinicians to make better use of laboratory testing.

All of us know stories and anecdotes about how certain of these forward thinkers tried to get their hospital or healthcare system to respond to projects which would add immense value through better application of certain laboratory tests. During the past decade, almost without exception, these initiatives proved disappointing. The reasons are legion and include turf issues, perceptions by clinicians that the lab is “telling them how to practice medicine,” and the decision by hospital administrators to shelve such projects in favor of other priorities.

However, the arrival of a new generation of clinical decision support systems may soon change this status quo. As you will read on pages 9-14, Vanderbilt University Medical Center in Nashville, Tennessee has implemented such a system. Called “WizOrder”, it is generating impressive benefits, some of which involve laboratory test utilization. What is equally interesting is that McKesson Corporation was impressed enough with WizOrders that it has licensed the right to offer it to other hospitals and health systems. It will use the brand name “Horizon Expert Orders™.”

McKesson has already linked the use of Horizon Expert Orders to better hospital performance in the clinical decision support criteria set out by the Leapfrog Group (see TDR, February 18, 2002). An early purchaser of Horizon Expert Orders is St. Luke’s Episcopal Hospital, located in Houston, Texas. St. Luke’s has stated publicly that it considers the knowledge library, which contains 900 different clinical protocols, outlines, rules, and advisories, to be a “starter set” for its own guidelines on ordering and treatment recommendations.

I recommend that lab executives and pathologists pay close attention to this current generation of clinical decision support systems. I predict that they will transform the way physicians order lab tests and use the resulting data, not the least because electronic systems can capture and rank physician performance. But more importantly, I make this recommendation because it will open new opportunities for trained laboratorians and pathologists to contribute greater value to the healthcare community they serve.


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