The hospital’s Senior Assistant Chief Medical Officer and Head of Pharmacy shares how CDSS has uplifted quality of care while improving operational efficiency.
Note: At the time of the provided testimonial, UpToDate Lexidrug was called Lexicomp.
When Cardinal Santos Medical Center (CSMC) embarked on their digitalisation journey years ago, the goal was clear. The hospital was not simply digitalising for the sake of doing so – but seeking to leverage technology to drive clinical excellence and outcomes for their patients.
A key pillar of this transformation was the adoption of clinical decision support systems (CDSS). CSMC has adopted a suite of three complementary CDSS products from Wolters Kluwer – starting with UpToDate Lexidrug (formerly Lexicomp) in 2014, and subsequently adding UpToDate in 2017, and Medi-Span in March 2021.
The hospital made the decision as it saw the potential of CDSS in supporting its clinicians to make the best clinical and treatment decisions for their patients.
“As we all know, medicine is a very dynamic science. What may be relevant yesterday may not be applicable today,” said Dr Rosemarie V. Serrano, Senior Assistant Chief Medical Officer at CSMC.
“Our hospital management believed that to improve patient care and management, it is crucial that we help our clinicians keep abreast of the latest clinical developments. We needed a learning resource portal for clinicians to access the latest research studies or trials. We also realised that our medical trainees need a ready reference to support their learning.”
Easy access to relevant, updated clinical information
Though there were numerous CDSS providers in the market, CSMC decided upon Wolters Kluwer based on the user-friendliness and accessibility of its tools.
Dr Serrano pointed to the hospital’s previous experience with another digital tool which proved difficult for users to pick up. To no surprise, the adoption rate was persistently low – defeating the purpose of adopting the tool in the first place.
UpToDate proved to be easy to navigate, affirmed Dr Serrano.
“The first time I logged in to UpToDate – voila, everything I needed was there,” she recalled. “The sections were clearly labelled. The layout is very visual, and I do not have to click many times before I get what I want. The search function is also extremely useful.”
In addition, being easily accessible by users, the tool is helpful for busy doctors who want quick answers on the go, whenever and wherever they are.
As a practicing pediatrician, Dr Serrano is a frequent user of the UpToDate tool, appreciating the convenience and value it provides to her.
“I often use the calculator feature, where I can put in the numbers for medical formulas like BMI and get the answers instantly. It really helps us busy doctors save time when we do our rounds,” she said. “I also love the patient education section, which I know is crafted by my fellow doctors. It helps us explain to our patients, in common language, about their conditions. The sections on latest updates, new journals and drug interactions are all very relevant and useful for us,” she said.
Guiding informed, quality medication decisions
On the other hand, Medi-Span provides CSMC clinicians with a comprehensive database of trusted drug information to support medication-related decisions. It screens patient-specific information to flag potential adverse events, and deliver evidence-based contextualized recommendations. For example, it alerts the prescribing physician if there are any drug allergies, inappropriate dosing, and potential drug-to-drug interactions or therapeutic duplications. This is critical especially in complex cases where multiple drugs are ordered by various health care providers.
It is complemented by UpToDate Lexidrug, a full-suite drug information reference containing monographs with the latest evidence-based recommendations to support the safe and appropriate use of medications. Importantly, it helps provide clinicians quick access to relevant information about novel drugs, off-label indications, and dose adjustments in special populations.
Ms. Pamela E. Mendoza, Head of CSMC’s Pharmacy Department, reiterated how these tools have safeguarded medication safety while improving work efficiency at the hospital.
“A clinical drug support system plays a crucial role in healthcare by helping clinicians make informed decisions about medications. It provides real-time information about drug interactions, dosages, allergies, and patient-specific factors, ensuring safer and more effective treatments,” she noted.
“When it comes to medicine, drug appropriate review is fundamental. Drug, dose, route, and frequency are only some of the pertinent details that are treated with utmost importance. We cater to hundreds of patients on a daily basis. The heavy burden taken from us by integrating CDSS into our system has made an impact not only in patient care, but also the ease of lifting heavy workload from our healthcare providers and safeguard our patients from error. Now we can focus on other crucial aspects of our work.”
"Overall, this technology reduces medication errors, enhances patient outcomes, and improves overall healthcare quality.”
Indeed, the hospital has seen a reduction in medication errors and adverse events. Meanwhile, adoption and usage rates of these CDSS have remained consistently high, with residents and fellows making up the majority of frequent users, together with medical trainees, nurses and even consultants.
Benchmarking against top hospital best practices
Notably, clinical pathways within UpToDate have been instrumental in helping CSMC to create their own customised pathways. Clinical pathways are standardised sequences of treatment protocols, aimed at guiding evidence-based medicine and reducing variability of care.
“All of our major clinical departments have their own set of clinical pathways now,” explained Dr Serrano.
“For example, in Pediatrics, we have clinical pathways for acute gastroenteritis or pneumonia; and in Obstetrics & Gynaecology, pathways for normal spontaneous delivery. Clinical pathways are particularly helpful in the emergency department where the pace is extremely fast, by helping to reduce delays.
“We're still continuously improving and adding on our arsenal of pathways, and have integrated almost all of these pathways into our EMR system.”
Perhaps most importantly, the tool has become a key resource in the hospital’s constant efforts to achieve ever-higher levels of quality.
“This tool provides us a reference for benchmarking hospital best practices. Our staff regularly refer to information from UpToDate for continuous quality improvement – to rethink how we conduct certain processes or validate what we are already doing. This covers different major areas of work at the hospital, from infection control to fall prevention and management,” Dr Serrano concluded.