CDS 2016
Providers Expect EMRs to Drive CDS Impact

CDS Solutions Fall Short of Desired Impact; VBC Driving Energy

The most adopted and impactful CDS tools, e.g., disease reference solutions and order sets, are embedded in workflows. Disease reference solutions often work seamlessly in the background and won't require a lot of attention from providers in the future. Order set content is a much larger focus; today, providers are primarily the ones to update it since integration of third-party solutions is a challenge. Once considered the next big area of CDS, surveillance is still finding its way in healthcare. With the shift toward value-based care, many still see huge potential for enterprise-wide surveillance to be used with interdisciplinary care plans and conditions like sepsis, though neither use is prevalent today.

1. Providers Look to Cerner and Epic for Future CDS Initiatives; McKesson, MEDITECH Not Ready

Due to ongoing integration goals, providers are shifting their CDS strategies to focus on EMRs. They want more EMR-supplied tools from Epic, Cerner, and Allscripts for order sets, surveillance, infection control, and care plans, with Allscripts sites requesting deep customization. Some providers cite MEDITECH's approach as too reactive but are optimistic about forward-thinking tools within the 6.x platform for things like sepsis. McKesson customers are focused on getting their EMR working smoothly.

Having improved over the past two years, Zynx Health has emerged as the top-performing order set vendor. Customers benefit from strong service, better-set expectations (especially around integration challenges), and good overall follow-through. Wolters Kluwer generally meets needs, but performance has dropped recently due to unrealistic expectations around EMR integration. Overall, two-thirds of respondents are not using a third-party vendor, since updating order set content is laborious regardless of approach.

Wolters Kluwer leads the third-party surveillance vendors, coupling a stable product with attentive, accommodating service. Responsiveness to customer requests has declined since Premier acquired TheraDoc. 35% of customers plan to switch, many to their EMR vendor. The industry's shift to value is driving increased awareness of enterprise-wide surveillance, with providers looking to their EMRs as the answer. Today, many customers leverage Cerner's sepsis tool; Epic has a few live surveillance customers; several MEDITECH customers have noted broad-ranging surveillance applications within 6.x.

Though Elsevier, Wolters Kluwer, and Zynx all offer evidence-based content that meets nurses' expectations, care plan adoption has not taken off. Care plans are a focus for 43% of organizations, who see interdisciplinary care plans as critical to success with value-based care. All vendors have generally good support, but each is cited for specific areas needing improvement: As with other vendors, Zynx's content can be labor intensive to tie into the EMR; Elsevier's usability and user interface need enhancement; and Wolters Kluwer lags in development and post-implementation follow-up.

Disease reference tools are the most widely adopted CDS applications. Despite frustrations over high cost, UpToDate's ubiquity and workflow integration are unique factors positively impacting outcomes. A few organizations are looking at long-time librarian favorite and overall score leader EBSCO as an alternative. They feel EBSCO's lower-cost DynaMed Plus content is on par with UpToDate, allowing them to switch. Elsevier's adoption lags overall, and their performance is lower due to inconsistent support.

Diagnostic support vendors perform well, yet lag in adoption. VisualDx offers strong tools for helping diagnose various skin conditions. Isabel offers broader diagnostics with an improved engine. It has not caught on with physicians, who tend to follow their own guidelines and workflow.

BD provides a robust product and works closely with users to generate value. Wolters Kluwer's product is easy to use, and the vendor has recently improved their service. Premier's support has become increasingly inconsistent, ranging from amazing to unresponsive. 25% of respondents are planning to leave. Predicting an ROI for third-party solutions can be difficult, so providers are looking to their EMR. Cerner's solution is immature and has a minimal impact; providers are still optimistic about its development. Epic's platform is widely anticipated; adoption is limited to date. No MEDITECH or Allscripts customers mention an infection control solution from their EMR vendor.