CDS Technology: A Value Proposition for MU

The following is a guest blog post by Bonnie Briggs, Director of Product Management for Wolters Kluwer Health.

As the industry turns towards Stage 2 Meaningful Use (MU) attestation with greater urgency and anticipates the forthcoming criteria for Stage 3 and beyond, healthcare providers are increasingly looking for effective ways to streamline compliance and best position for the future. With so many initiatives competing for limited dollars, the value proposition of any health IT investment is critical to meeting current and future regulatory objectives—and qualifying for attractive incentive payments that can deliver a whopping $7 million to the average 200-bed hospital for Stage 2 alone (based on the current Medicare share and transition factor).

As MU moves past the Stage 1 focus of basic data capture within an EHR, healthcare organizations need to lay a foundation to address the more advanced clinical processes and improved outcomes focus of Stages 2 and 3. Use of clinical decision support (CDS) technology at the point of care is a focal point of compliance as it sets the stage for greater adoption of evidenced-based practices to improve outcomes.

While drug reference and drug interaction data applications are obvious choices for meeting Stage 2 MU CDS requirements for drug-drug, drug-allergy and drug-disease interactions screenings, healthcare organizations need to consider that not all solutions are advanced enough to address other key MU requirements, namely patient education/engagement requirements and HL7 Infobutton capability. Specifically, the industry’s most advanced products can help fill in the gaps by providing appropriate tools for educating and engaging patients and linking clinicians to the most relevant content.

Addressing Patient Education and Limited Health Literacy

Industry research reveals that there is a considerable disconnect between the language of clinicians and the ability of patients to comprehend the relevance and importance of what is being communicated. In fact, nearly half of American adults have some level of limited health literacy when it comes to using and understanding written health information alone, according to the Institute of Medicine (IOM).

One area that has become a focal point of regulatory discussion related to patient education and health literacy is the need to accommodate non-English-speaking patients. The National Standards on Culturally and Linguistically Appropriate Services (CLAS) states that “health care organizations must make available easily understood patient-related materials and post signage in the languages of the commonly encountered groups and/or groups represented in the service areas.”

While Stage 2 MU requirements call for the use of EHRs to identify patient-specific education resources, Stage 3 recommendations released by the HITPC Meaningful Use Workgroup earlier this year point to the potential of this rule being expanded to support language needs. Specifically, the recommendation calls for the “use of CEHRT capability to provide patient-specific educational material in non-English speaking patients’ preferred language.”

When considering the value proposition behind the use of CDS technology in the form of drug reference applications, the availability of consumer-level content that addresses a broad array of foreign languages should be considered to best position for compliance going forward. Industry recommendations also suggest that materials be written on a 5th to 7th grade level, using simple sentence structures and short, bulleted statements for easy reading. Other key considerations for effectively engaging patients include age-appropriate illustrations and the provision of materials in larger fonts for the visually impaired.

The Infobutton Challenge

Compliance with MU patient education standards also means that certified EHRs must support the Health Level 7 International Context-Aware Knowledge Retrieval standard, more commonly referred to as the HL7 Infobutton. This industry standard must be used to access patient-specific education materials based on relevance. It may also provide links to referential CDS as an option.

A widely accepted and adopted standard, the Infobutton essentially enables EHRs to generate a view of a patient encounter based on standard patient and provider information. From that information, an EHR application can gather appropriate patient education materials based on the specific details of that case at the click of a button.

The challenge for healthcare organizations will be identifying CDS applications that are equipped to gather patient data in this way. When advanced drug reference applications can aggregate this information from problem lists, medication lists and laboratory results and support Infobutton contextual parameters for identifying appropriate knowledge resources, the value proposition as it pertains to MU compliance is heightened.


When positioning for effective use of CDS at the point of care to meet current and future MU objectives, healthcare organizations need to be careful of making knee-jerk decisions and consider the best technological foundations for long-term success.

While a number of CDS applications on the market can address the basics of drug-drug, drug-allergy and drug-disease interactions screenings, not all are equipped for the broader patient education focus currently unfolding. Considerations should be made for addressing the bigger picture of health literacy and evolving industry standards such as HL7 Infobutton capability.

Bonnie Briggs, RPh, MBA, is the Director of Product Management for Wolters Kluwer Health. She can be reached at