Clinical pathways are an integral part of any healthcare system. They provide best practice guidelines and recommendations for various pathologies. Using clinical decision support (CDS) tools, healthcare teams can make evidence-based, clinically validated, and standardized decisions to improve the quality of care delivered to patients.

The CDS marketplace is growing, expected to eclipse $1.5 billion by 2021. What’s interesting though is how little emphasis seems to be placed on actual CDS adherence -- the most important part.

Time and time again, we hear about hospitals investing significant capital to develop or purchase new CDS solutions. Yet they have no idea if these solutions ever make it into practice in a meaningful way, and they lack the ability to see if those interventions are working rapidly. Hospitals often don’t have processes in place to track clinical adherence, outcomes measures, and frequency of use of CDS tools.

Here we discuss how FHIR, the EMR interoperability protocol, is making adherence tracking possible like never before. Using FHIR, we can extract real-time data insights to improve and optimize clinical workflows, thereby standardizing best practices. These new capabilities are revolutionizing our approach to CDS.

Why has clinical adherence fallen under the radar?

A recent NEHI study suggested that two important barriers to CDS adherence, among others, are that 1) physicians are entrenched in set beliefs and habits, and 2) information technology systems aren’t sophisticated enough to help.

At Impathiq, we think a big reason adherence has fallen under the radar is because of how hard it is to track. It has proven difficult to determine if and when a healthcare provider actually used the CDS in the clinical workflow and in what context. We also fail to provide CDS at the right time or in the right context to the physicians and nurses when they need it most, which leads to non-adherence as well.

FHIR enables real-time clinical adherence tracking.

FHIR has opened up the capability to track clinical pathway usage that was not possible before. For example, FHIR-based apps can be contextually triggered in key clinical scenarios and use data can be gathered in these clinical contexts. It makes no sense to implement a clinical care pathway and not track if it’s being utilized in real-time. We refer to this type of tracking as clinical adherence tracking.

By utilizing clinical adherence tracking on our first FHIR app, an Emergency Room chest pain care pathway, we were able to achieve 90%+ clinical adherence. When physicians and fellow clinicians know how they are performing compared to their peers on best practices, it’s amazing to see how their practice improves. FHIR provides a scalable means for real-time adherence tracking, best practices and standardization in patient care.

Clinical Adherence Tracking - Impathiq

Clinical adherence tracking in real-time using Impathiq’s IQ Engine and FHIR APIs

What Does This Mean for Your Hospital?

FHIR enables smart triggering of CDS within the clinical workflow, along with real-time tracking of use and adherence to clinical protocols. This is critical to standardizing care and ensuring best practices across departments, providers, and hospitals. Furthermore, it enables administrators to provide education and incentivization for healthcare teams based on these metrics.

At Impathiq, we believe that FHIR technology is a gamechanger for improving care pathways, clinical decision support and patient outcomes. If your health system wants to learn more about FHIR apps and how they work on Cerner, Epic, or other EHRs, don’t hesitate to reach out to us.

Vinay Tannan, PhD Chief Operating Officer LinkedIn Twitter