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The Promise of Clinician-triggered Clinical Decision Support Solutions

Clinical care guidelines are a good thing…

Accountable care, evidence-based care, guideline directed medical therapy are all buzzwords these days, for good reason — care based on standards and evidence-based guidelines has been shown to improve the quality of care, save lives, and prevent unnecessary, costly treatment, procedures and hospitalizations.

…but implementing them is challenging.

The idealism of evidence-based care, however, clashes with the reality of medical practice today. Do these challenges resonate with you or your clinical staff?

  • Best practices just never got communicated or internalized
  • Guideline directed management is too general and can’t possibly apply to every patient perfectly
  • Guidelines are constantly being updated and are becoming increasingly complex
  • Adhering to guidelines is time consuming
  • There are no financial benefits to implementing guidelines, especially with decreasing reimbursements

As a result, we hear regular laments in the literature about how only a minority of patients are getting care based on a specific guideline even though the guidelines are widely available.

Current clinical decision support tools and solutions offer great information but it is just one source of information that a clinician considers.

Current Clinical Decision Support tools and solutions have no doubt brought a great deal of value to physicians and patients, e.g. online reference tools and mobile applications with automated system message pop-up notifications, however, busy clinicians like me often find these alerts distracting and lacking full context. I use a number of these tools (MD Calc, UpToDate, etc.) but I have found that they provide me with generalized information about a care guideline, which I must then hunt for and review pertinent details of my patients’ conditions to determine whether and how it applies. How many of you have ever spent time searching for a critical lab detail for a patient in your EHR, just to determine whether the guideline you searched for in UpToDate applies? Even the built in EHR clinical decision support alerts have for me been irrelevant or rudimentary.

I’d like to utilize all the patient data from my EHR, but it just seems impossible!

So what is the solution? Is there a solution? An unlikely ally in helping clinicians practice evidence based care may be the much-maligned electronic health record (EHR). As many of you may agree, I often feel like I spend twice as much time in my EHR than face to face with my patients. I also admit to resenting my EHR because it is clunky, poorly designed and time consuming. However, there is a gold mine of patient data in there. For years I wondered, what if there was a tool to capture that data, apply it against evidence based algorithms and give the patient recommendations for care while I am in the exam room? Such a tool would help clinicians practice evidence-based care without having to spend a lot of time reading a long complex guideline and then deciding how to apply it to the patient, all within the workflow of an office visit.

With Infera, clinicians are in control and, most importantly, receive the most relevant and current care recommendations based on an individual patient’s condition.

My vision for this tool starts with the clinician – with them triggering the decision making process when it is necessary for additional evidence-based guidance and at the same time utilizing the gold mine of information in the EHR. Some companies are starting to build such tools although they are limited by the reluctance of EHR companies to integrate with them. However, there are forward thinking EHR companies such as Allscripts and Athena which have opened their APIs to allow outside developers to harness the patient data contained in a patient chart to provide specific personalized recommendations. Because these forward thinking companies exist, it allows applications like Infera the opportunity to integrate with their EHR systems. You can check out our product here: https://allscripts-store.prod.iapps.com/applications/id-16018/Infera

New protocols such as FHIR and CDS Hooks should help specialized clinical decision support tools like Infera to realize their full potential. Market forces and government encouragement should nudge all major EHR companies to open up APIs to outside developers.  As I say every day to my colleagues at Inferscience – Such a day could not come soon enough!