The general concept behind clinical decision support is great. It includes software and processes to help doctors and other clinicians make appropriate care decisions by delivering clinical knowledge and patient data tailored to the situation at hand. Especially in our age of information overload, it’s hard to keep abreast of all the latest on specific procedures, and CDS can act as that expert by your side.
In addition, important patient information could be located in multiple places within an electronic health record, and intelligent software for decision support can help synthesize all that information. Imagine how patient safety, for example, can be more efficiently protected when a doctor is immediately alerted when a patient who has metal in her body is scheduled-erroneously-for an MRI.
Here are some of the other features provided by clinical decision support:
- Warnings regarding drug-drug interactions, allergies, and dose range
- Mechanisms for automatic selection of standardized, evidence-based order sets (packages of orders for a clinical scenario)
- Links to knowledge references
- Safety alerts
- Rules that promote adherence to clinical best practices and achievement of quality measures
- Delivery of evidence-based care guidelines at the point of care.
So, with all these benefits, what’s the issue?
The tools, implementation, and rationale for clinical decision support vary widely. And some of the mechanisms of this support-namely, alerts that fire too frequently and operate in interrupt mode-have given clinical decision support a bad name.
When clinical decision support is rolled out because of external requirements, such as to obtain reimbursement for Medicare services or to help meet regulatory requirements, it can get off on the wrong foot. For some clinicians, for example, the automatic application of evidence-based guidelines is tantamount to “cook book medicine” and limits their autonomy. And it bears repeating: No one likes being interrupted in the middle of carrying out their responsibilities.
The fact remains, though, that clinical decision support can reduce errors, promote best practices, and eliminate unnecessary procedures that bring associated costs and potential harm to patients.
All of us, including physicians, are creatures of habit and most of us will tend to believe that what we’ve always known is correct, even if new evidence contradicts that. As reported in a recent article in The Atlantic and ProPublica:
It is distressingly ordinary for patients to get treatments that research has shown are ineffective or even dangerous. Sometimes doctors simply haven’t kept up with the science. Other times doctors know the state of play perfectly well but continue to deliver these treatments because it’s profitable-or even because they’re popular and patients demand them. Some procedures are implemented based on studies that did not prove whether they really worked in the first place. Others were initially supported by evidence but then were contradicted by better evidence, and yet these procedures have remained the standards of care for years, or decades.