If you ask any doctor about the biggest challenges facing them today, they are likely to say they are under constant pressure to do more, with less time and fewer resources. They need help. Technology is coming to their aid in many different ways, making the health tech industry a hotbed of growth and innovation. One area that answers many of these key challenges faced by clinicians is decision support technology – also known as Clinical Decision Support (CDS).
Broadly speaking, CDS is workflow technology, allowing clinicians to support their decisions with evidence-based information regarding diagnoses, treatment recommendations, or drug prescriptions. It allows the clinician to quickly access accurate and authoritative information exactly when they need it most – at the point of care – and in the most convenient way.
Minimising variability in care
This is a broad sector and CDS means different things to different users. At the basic end of the scale, some think of CDS as hospital system alerts or care suggestions. In its more sophisticated form, CDS solutions like UpToDate or Medi-Span Clinical can be powerful tools to help support decisions around the individual patient and often linking to the electronic patient record (EPR). At the simplest end of this broad scale, you could argue that CDS is a passive information resource. At the more sophisticated end, it becomes an interactive workflow tool.
The growth of CDS is being driven by human needs, the economics of healthcare, and the evolution of enabling technology. One of the biggest factors behind its growth is a desire to minimise high variability in patient care. There is no reason why patients should receive different treatments based solely upon which doctor they happen to see and where they happen to see them, especially if there is scientific evidence supporting specific approaches. Yet such variability continues to be common throughout the world. For example, according to figures from the Organization for Economic Cooperation and Development, the mortality rate for prostate cancer in Denmark is roughly double the rate in Italy.
Unwanted variability leads to waste and potentially harms patients and CDS offers a compelling approach by helping drive standardised, evidence-based care across organisations and healthcare systems.
Another important trend that makes a strong case for CDS is the explosion in the volume of medical information. Scientific knowledge continues to evolve, leading to the introduction of new drugs, treatments and diagnostic tests. Thus, clinicians face the task of continuously refreshing their knowledge to an extent where they feel comfortable changing their practice. The task of keeping up with all the advances in medicine, much less gaining experience in using newer options, is challenging.
As a result, it is becoming increasingly difficult for today’s time-pressed doctors to stay ahead of this avalanche of new information, covering everything from treatment recommendations to new research and procedures, and the amount is growing all the time. As one review noted, the time taken for medical knowledge to double in 1950 was estimated to be 50 years. By 1980, that had shrunk to seven years and by 2010 it was only 3.5. By 2020, it will only take 73 days for the volume of medical knowledge to double. This presents a real challenge for clinicians.
So, what is the impact on care? One key finding is that clinical decision support can be instrumental in helping clinicians decide on the optimal course of therapy and ensuring that the right therapy is recommended. Several studies and systematic reviews have supported a benefit from clinical decision support systems.
Clinical decision support can also be combined with other interventions aimed at turning knowledge into practical experience. A study by the General Medical Council (GMC) in the UK found that newly qualified junior doctors can struggle with complex clinical decision-making and can make prescribing errors at up to twice the rate of other health professionals. A study of junior doctors in the UK evaluated the impact of feedback on medication prescribing, along with eLearning, simulation and access to UpToDate on mobile devices. By the end of the study, medication errors were reduced by 50 per cent.
These benefits for efficiency have the potential to translate into real cost savings. At one of the largest UK hospitals that uses the technology (Salford Royal NHS Foundation Trust), a case study focused on its use found that the service improves quality of care and in turn has a positive impact on key hospital metrics such as mortality rates, waiting times, readmission rates and length of stay, faster diagnosis and a reduced time to treatment.
All of this shows how CDS technology fits in with our efforts in the region to find systematic solutions for driving down costs through efficiency gains while delivering world-class standards of patient care.
Clinical decision support in the workflow
We cannot know what the future entails, however clinicians and research findings today concur that CDS in the workflow helps support decision-making. The key to the successful and effective implementation of CDS is that it needs to be ‘smart’. Information needs to be delivered in a way that is seamlessly embedded into the physician’s workflow, supporting his or her reasoning process – not replacing it. When CDS technology can be embedded into an Electronic Health Record (EHR), which is already the case with UpToDate in many hospitals, then it moves from being an information resource to a personalised and dynamic tool. When an EHR is not available, some forms of CDS can be accessed on desktop computers or mobile devices.
A guiding principle for the use of this powerful technology is that it needs to support the decision-making process rather than replace it. It recognises that clinicians can’t be expected to know everything so CDS technology is about giving clinicians the tools that ultimately help them make the right decisions at the right time – helping the patient receive better and safer care, while supporting a more efficient delivery of care service.
Wolters Kluwer provides trusted clinical technology and evidence-based solutions that engage clinicians, patients, researchers, students, and the next generation of healthcare providers. With a focus on clinical effectiveness, lifelong learning, and clinical intelligence, the company’s proven solutions drive effective decision-making and consistent outcomes across the continuum of care.
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References available on request.