Question

Discuss how the development of Clinical Decision Support (CDS) standards and statewide health information exchanges (HIEs) are essential to the national adoption of CDS. How does CDS align with the goal of rewarding "quality over quantity" in healthcare reimbursement? Based on your research and response, does this favor the adoption of CDS or argue against it?

Answer 1

CDS is Clinical Decision Support : This system provides a support for the physicians, all the health care members and also the patients effectively in insurance claiming process.

Health Information Exchange : Transfer or exchange of health information electronically to the doctors, Nurses and other health care staff.

National adoption of CDS and HIE

• It's very crucial for the development of both in multiple terms for the adoption of both by National wide.
• CDS always focuses on Quality but there should be some of the areas to be improved .
• An example stating CDS follows Quality :

CDS works with the facilities or hospitals in deciding diagnostic codes and also raising queries about the condition of the patient condition for the clinical decision support and getting queries resolved so that the case might move to other population of diagnostic codes.

Example of CMS guidelines for a Stroke Case and CDS evaluation:

• A patient was admitted with for Stroke signs and symptoms and got discharged.
• His medical documents states that the patient is having previous history of Stroke
• All the diagnostics such as CT head are normal
• But the case was coded as Cerebral Infarction as the primary diagnosis.
• When CDS reviewed they found that this is actually case with the history of Transient Ischemic Attack and also history of Stroke.
• His discharge medications does not have the list of Statins and also discharge antithrombotics.
• So CDS team raises a query to the physician stating all the details and the reason for not given the discharge medications.
• Physician responds to the query stating that patient is only having the history of Stroke and so there is no need of Statins are antithrombotics.
• According to the CMS guidelines If the patient is diagnosed with Stroke there should be some of the medications to be administered at discharge.
• So this process helps the facilities to get proper reimbursement.
• It benefits the facilities and also patients to maintain guidelines and standards according to CMS and also getting clinical documentation support to justify the diagnostic codes.
• So here for example patient is actually a Stroke patient and it is coded as unspecified cerebral infarction , there is also a need of clinical documentation support for the patient to qualify for the reimbursement according to CMS guidelines.

​​​​​​​From the above scenario it is clear that CDS maintains quality in terms of documentations but it should be improved in areas of developing diagnostic codes in terms of documentation.

Also there should be auto improvement of providing codes according to the latest information transferred by the Health Information Management.

The example of quality maintained can support National adoption but only with the advanced improvements.