Opportunities to Increase the Effectiveness of EHR-Based Diabetes Clinical Decision Support
18 May 2011
accepted: 03 July 2011
16 December 2017 (online)
There are many opportunities to improve diabetes care through more effective use of EHR-based CDS. The report of Kantor et al.  is encouraging because it demonstrates sustained efforts by leading health care organizations to implement diabetes-related EHR-based CDS. However, lack of sophisticated treatment-specific CDS and lack of prioritized recommendations are a cause for concern. Even more disturbing is the substantive heterogeneity in content of diabetes CDS recommendations now in the field. Some of CDS recommendations described by Kantor et al.  are clearly not evidence-based and could increase costs while not improving clinical benefits. The timely identification of these problems is an awkward but necessary first step towards improvement. The health care organizations that are pioneers in the field should be congratulated and encouraged to continue their collaborative efforts to increase the efficiency and effectiveness of EHR-based CDS. Attending to the modest proposals put forward here and by others may help translate the massive investments that we have made in EHR technology into clinical benefits for our patients.
- 1 Meigs JB, Cagliero E, Dubey A. et al. A controlled trial of web-based diabetes disease management: the MGH diabetes primary care improvement project. Diabetes Care 2003; 26: 750-757.
- 2 Montori VM, Dinneen SF, Gorman CA. et al. The impact of planned care and a diabetes electronic management system on community-based diabetes care: the Mayo Health System Diabetes Translation Project. Diabetes Care 2002; 25: 1952-1952.
- 3 Crosson JC, Stroebel C, Scott JG. et al. Implementing an electronic medical record in a family medicine practice: communication, decision making, and conflict. Ann Fam Med 2005; 3: 307-307.
- 4 O’Connor PJ. Electronic medical records and diabetes care improvement: Are we waiting for Godot?. Diabetes Care 2003; 26: 942-943.
- 5 O’Connor PJ, Sperl-Hillen JM, Rush WA. et al. Impact of electronic health record clinical decision support on diabetes care: a randomized trial. Ann Fam Med 2011; 9: 12-21.
- 6 Bates DW, Bitton A. The future of health information technology in the patient-centered medical home. Health Aff (Millwood) 2010; 29: 614-621.
- 7 Koppel R, Metlay JP, Cohen A. et al. Role of computerized physician order entry systems in facilitating medication errors. JAMA 2005; 293: 1197-1203.
- 8 ICSI.. Diagnosis and Management of Type 2 Diabetes Mellitus in Adults. 14th Edition July 2010 ed., Institute for Clinical Systems Improvement; Bloomington, MN.:
- 9 IOM.. Clinical Practice Guidelines We Can Trust,. In Institute of Medicine; 2011
- 10 American Diabetes Association.. Standards of medical care in diabetes –2011. Diabetes Care 2011; 34: s11-s61.
- 11 American Association of Clinical Endocrinologists.. ACE consensus conference on guidelines for glycemic control 2001. Available at: www.aace.com/pub/press/releases/diabetesconsensuswhitepaper.php.
- 12 Eledrisi M. Comments on the AACE/ACE statement on glycemic control for patients with type 2 diabetes mellitus. Endocr Pract 2010; 16: 130–131; author reply: 131-132.
- 13 Rodbard HW, Jellinger PS. The American Association of Clinical Endocrinologists/American College of Endocrinology (AACE/ACE) algorithm for managing glycaemia in patients with type 2 diabetes mellitus: comparison with the ADA/EASD algorithm. Diabetologia 2010; 53: 2458-2460.
- 14 AACE.. American Association of Clinical Endocrinologists Medical Guidelines for Developing a Diabetes Mellitus Comprehensive Care Plan 2011) (AACE, Ed.).
- 15 American Diabetes Association. Standards of Medical Care in Diabetes –2011. Diabetes Care 2011; 34: S97.
- 16 Kantor M, Wright A, Burton M. et al. Comparison of computer-based clinical decision support systems and content for diabetes mellitus. Appl Clin Inf 2011; 2: 284-303.