clinical decision support systems

There exists a  healthcare blueprint for achieving better patient outcomes and as it has been, it involves putting the right type of processed data in the hands of the helper.

Personal, Communal and Personalised

Like a broken record, I keep telling everyone that next to actively maintaining a healthy lifestyle, having a doctor as a close friend, is an investment that will reap dividends.  A personal medical referral affords the patient with personalised care which comes in the form of ‘special’ care and medical treatment generally reserved for those with plenty of cash to spare.  And even better, this favor usually extends to family and friends as well.

Why?  Because complementing the medical meritocracy, the healthcare journey still traditionally goes through familial and social networks for a patient seeking medical services and treatment.  

To put it simply, healthcare success has and will always be personal, at the start.

Take for example the story of Kathy Halamka who was diagnosed with cancer and how having a doctor for a husband enabled her journey towards the best care services possible.

Personal to Informational
But before you jump into a ‘familial’ conclusion, the story doesn’t focus on the benefits of having a medically-trained family member but on how the decisions that guided Kathy’s therapy — using evidence-based protocols from available clinical data, is creating a strong case for its adoption in a healthcare industry still undecided about making technology investments.

Hospitals focused on patient care cannot ignore the fact that “the complexity of medicine now exceeds the capacity of the human mind”, according to  Ziad Obermeyer, MD, and Thomas H. Lee, MD in the New England Journal of Medicine  and further adds, ‘because physicians and nurses, despite their years of education and clinical experience, have cognitive limitations”.

Their article further states that, “No single clinician can retain the petabytes of medical research and patient records now available in many clinical decision support systems. Nor can they be expected to see all the correlations and patterns required to make a fully informed diagnosis. No doubt these shortcomings are partially responsible for the disturbing number of misdiagnoses reported in the scientific literature.”

The standard of care for cases like Kathy’s is typically chemotherapy followed by mastectomy.  But having access to digital resources presented them with new options and an opportunity to test a personalised medicine approach.

Smarter Care Transformation
To achieve personalised medicine requires a more technology-enabled healthcare system. However, this is proving to be a hard sell to hospitals struggling to secure budgets and zeroed in on cash returns on investment.  

At the granular level, the transformation needs to start with the culture — on how medicine is being practiced. As the author Paul Cerrato states,  “[the] new resources can transform the practice of medicine, but only if clinicians are willing to recognize the need for such tools.”

As former Cleveland Clinic CIO, Martin Harris proclaims, “We must reimagine a healthcare system that will be built upon capabilities and connections that simply did not exist just a few years ago. To envision a new kind of HIT-enabled system of care, we will need people who see the role of technology in a more integrated way.”

What is required of technology as a start is the kind that will give healthcare providers access  to available clinical information that can lead to actionable insights and its management which should effect and transform the practice of medicine.  

Evidence-based & Clinical Decisions
Clinics and hospitals who use systems that are capable of collecting and storing clinical data provides patients with a huge advantage compared to facilities that are still stuck with technology that is focused on operational and billing efficiency.

As illustrated in Kathy’s case, availability of patient clinical data (with privacy and security features in place) is a treasure trove of insights waiting to be discovered and applied to a populace seeking not just personalized medicine but therapies and medical regimen that are evidence-based.

As defined by Dr.  David Sackett (1996), evidence-based medicine is the conscientious, explicit and judicious use of current best evidence in making decisions about the care of the individual patient.  It requires the integration of the best research evidence, clinical expertise and the patient’s unique values and circumstances.

Clinical expertise comes from knowing how vital ‘clinical’ data is and putting them to good use.  It comes with good history taking, physical examination and years of experience and the patient’s values include social and cultural factors besides the individual’s ideas concerns and expectations.

The need and demand for evidence-based health care is expanding rapidly driven by a combination of these factors: information overload, rising patient expectations, the introduction of new technologies and ageing populations.

The use of clinical decision support (CDS) systems to facilitate the practice of evidence-based medicine (EBM) promises to substantially improve health care quality by its potential to reduce medical errors thus lift care quality.  By matching patient characteristics with established knowledge base, updated evidence from medical research literature and practice sources, clinical decision support challenges clinicians to carefully consider and reconsider before jumping to conclusions (and biases) by presenting them with other diagnostic possibilities that don’t readily come to mind.

Currently, the numbers for different types of clinical decision support technology are steadily increasing.  These include knowledge-based tools like UpToDate, which gives users access online to a massive repository of medical textbooks and journals and guides users through interactive algorithms that recommend tailored recommendations.

We are in an era where medical advances continue to provide proof for healthcare providers to consider reasons to integrate technology innovation to their respective medical practices.  Amidst the promise, the goal to improve patient outcomes has never been under this type of pressure and scrutiny.  From the push to use electronic medical records to other core hospital clinical systems and decision support tools, the realisation that medicine needs to move past the limits and biases of human decisions is a provoking thought for it means that patient care is still currently subject to hits and misses.  If we need to raise the bar, healthcare providers and institutions will need help, too, in order to help guide their patients towards the best possible health care and outcomes.

Check out our healthcare product, MEDCURIAL, and see how it helped some of the biggest hospitals in the country provide better patient outcomes.