August 13, 2008
Clinical Decision Support Tools Can Change The Practice Of Medicine
Clinical decision support(CDS) tools, technologies that provide information to aid the diagnosis and treatment of patients, are set to make dramatic changes to the practice of medicine, according to a new report by Datamonitor.
Early adopters of EHRs have begun adding more advanced functionalities, including CDS tools, to their EHRs. According to the report, EHRs without CDS, are not much more than a compilation of paper records in an electronic format. Since electronic formats can ofer so much more to the clinician, there is an increasing interest in CDS.
The types of CDS technologies "range from online reference materials and guidelines, through alerts built into electronic prescribing (eRx) and computerized physician order entry (CPOE), to data mining and artificial intelligence." Currently, CDS tools are geared toward providers such as hospitals, physicians, nurses, physician assistants, pharmacists and physical therapists. It is predicted that payers, such as governments and patients will use CDS to a greater extent in the future.
The report points out that medical culture will be the major obstacle to overcome in CDS adoption. and that "the 'art of medicine' is still highly regarded among providers. Critics of CDS maintain a computer cannot understand the nuances of medicine even when the technologies have been shown to improve efficiencies and outcomes. While a fundamental shift in culture is not impossible, it will take time as well as an increase in provider education and pressure from patients, payers and hospital executives.
As the healthcare system becomes more patient-centric, CDS will as well. This focus on individual patients will be evident in a number of ways. For example, alerts and reminders will be personalized to each patient and genetic information will be included in patient records. Patients will even use CDS tools themselves to help aid in their own diagnosis and treatment.
Implementing most CDS tools is difficult today particularly if the technology is not user friendly. CPOE with CDS, for example, is already widely accepted, but rarely used appropriately. The main complaint that physicians have regarding CPOE with CDS is that too many inappropriate alerts pop up on the computer screen. Providers begin to ignore the alerts, even the correct ones, negating the reason why the alerts were set up in the first place. Alerts and reminders need to be accurate, relevant to the patient, unobtrusive to the provider's workflow and quick to use. Tracking how alerts are used and which are over-ridden may be the most valuable information for early adopters to share with their peers.
The amount of clinical data available for research will grow exponentially with the greater adoption of EHRs, but the full value of the information collected will not be reached unless healthcare practitioners have the tools to analyze it. With the technology and information available today, providers should not be complacent with the current misdiagnosis rate. "If social networking tools like Facebook are able to predict who an individual might be friends with based on who he or she is already friends with, there is no reason that CDS should not be able to determine what diagnosis patients may have based on their health information. Despite the need to improve in this area, the use of CDS tools for diagnosis and computer-assisted diagnosis (CAD) technologies will be slow until a fundamental change in medical culture occurs."
Resources:
Evaluation of Decision Support Systems (2007)