Understanding the Evolution of Clinical Decision Support (CDS)

With the recent focus on evidence-based care and the innovation around medical technology, Clinical Decision Support (CDS) has never been more important. Recently, Health IT Outcomes published an article authored by Sage HMS founder Katherine Gray, PhD, which outlined the growing prominence of CDS in recent years.


According to the article, studies have shown that 17 percent of medical deaths were the result of diagnostic errors – more than the deaths resulting from medication errors. At the same time, orders for diagnostic imagery was exploding:


“Furthermore, from 1985-2005 radiology testing grew at double digit rates. Since 2005 the rate of increase in diagnostic imaging has diminished, although still growing, but not at such a rapid rate. Radiology procedures are used in approximately 10-15 percent of all patient encounters and account for nearly 10 percent of the total health care delivery costs in the U.S. Finally, many studies have shown that inappropriate ordering accounts for about 30-40 percent of all imaging.”


Despite all this, the acceptance of evidence-based standards still faces challenges. The article identifies three main ones:


  • Sheer coordination and implementation – embracing CDS involves almost every aspect of care delivery;
  • Multidisciplinary requirements – standards require not just the expertise of those conducting the imaging, but also needs to incorporate research from other medical areas and address rapidly changing technology;
  • Resistance to change – medical professionals resist any perceived impingement on autonomy, even as their workloads prevent them from staying abreast of new research and technology.


The passage of the Affordable Care Act (ACA) was also a game changer. The ACA established mandatory requirements that necessitated evidence-based standards and have advanced more efficient use of healthcare IT. The Center for Medicare and Medicaid Services’ (CMS) is now recognizing CDS solutions as a mechanism that are qualified to provide evidence-based imaging recommendations that supports Appropriate Use Criteria (AUC) based on legislation passed in 2014 (PAMA).


The Sage HMS RadWise solution gives providers the ability to consult robust, evidence-based knowledge for diagnostic imaging and receive AUC recommendations to meet CMS regulations for claims payment. The tool can be integrated into existing HIT systems, or can be provided as Software-as-a-Service. RadWise provides complete diagnostic information at the time and point of care, reduces inappropriate orders and meets claim requirements.


RadWise completes the CDS equation – better decision-making for patients and more efficient  reimbursement for providers.