Creating a Friendly Environment for Adoption of Clinical Decision Support

In recent years, our ability to stream large amounts of data in real-time has improved dramatically. This enhancement can transform how clinicians offer care by sourcing unprecedented opportunities for clinical decision support. However, the capability to process, store, and display data in and of itself does not transform care. Rather, it is how the clinicians adopt and apply decision support that will make all the difference to patients. However, the current environment must be altered to create a clinical decision support-friendly climate.

From a patient perspective, we must migrate away from automation of population-based models and toward a model that supports the individualization of care. From the clinician’s perspective, there is a thin line between enabling and burdening them with data. We need to find the right balance: empowering physicians to prescribe care using their training, experience, humanity, intelligence, and reason while giving them the technological support to catch and analyze what isn’t always obvious. If we are to make clinical decision support a reality, we must ensure that it is personalized, valuable, and adoptable.

There are a few things the industry needs to do to make this happen:

  1. Customize care: Each patient’s data, circumstances, responses, and care path will be unique. Clinical decision support is based on advanced analytics and calculated trends, but we must provide the patient-centered context to improve the accuracy of the final call. In the past, the industry has pushed for uniformity to the detriment of care and at the expense of patient individuality and physician autonomy. For example, clinical practice guidelines that do not allow for important patient-specific customizations are less than helpful. Guidelines tend to focus on populations and not people. We must not genericize the process of care. Our goal in providing more data and better care support should be to enable a patient-centric, unique plan upon which physicians can act immediately. This will require a convergence of clinical decision support, ready access to data, which has been transformed into actionable information, and alignment of customized medicine.
  1. Make it easy and put it in one place: As we move away from a one-size-fits-all approach, we also need to perfect interoperability and appropriate graphical user interfaces to improve ease of use, while getting the right information to the right person at the right time. In parallel, let’s also move away from the recent habit of “apping” our physicians to death. It isn’t efficient, and doctors aren’t learning to invest their effort into any particular application – they’re instead distracted and half-heartedly using a handful of various mobile tools. If physicians enjoyed true interoperability, data would be streaming through multiple processors to do digital background work for them and, in turn, providing patient-specific choices A, B and C. The key is giving clinicians options, rather than an answer, and in saving steps to make clinical workflow more efficient.
  1. Push for real reform: We must better align incentives for key stakeholders around innovation. Reform must move beyond its current focus on payment and access. We need fundamental changes in 1) physician training, behavior, and adoption; 2) incentives for the commercial life science industry; and 3) regulatory agency policies and practices.[i] Today we can leverage voluminous data, transform it into actionable information, and get it to a physician via a mobile device – essentially in near real-time. Getting physicians to embrace clinical decision support will require aligning incentives, embracing innovation, providing interoperability, and earning their trust.

Healthcare must be centered on the unique needs of individual patients. Providers need technology that powers customized, patient-centric clinical decision support. Expanding the scope of health care reform will foster an environment of innovation. Inside this new realm of creativity, physicians will actually be empowered and incentivized to actively leverage emerging technology to help transform care.

[i] Topol, E. 2012. The Creative Destruction of Medicine: How the Digital Revolution Will Create Better Health Care. Basic Books. New York, NY. ISBN-13: 9780465025503.

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