Note: Roche is building a new suite of clinical decision support solutions on the Innovaccer Health Cloud. You can read the announcement, “Innovaccer Announces Collaboration with Roche to Develop Clinical Decision Support and Workflow Solutions“ for more information.The Theory and Promise of Clinical Decision Support Systems
Clinical Decision Support (CDS) systems have been used in healthcare since the early 1980s. But have they lived up to their promise? And if not, what’s holding them back?
In theory, clinical decision support can significantly impact improvements in quality, safety, efficiency, and effectiveness of health care. They provide clinicians, staff, patients, payers, and other stakeholders with, ideally, evidence-based knowledge and patient-specific information at the right time to enhance healthcare delivery and population health overall.
That’s according to the CMS. Moreover, the Office of the National Coordinator for Health IT (ONC) supports industry efforts to develop, adopt, implement, and evaluate the use of CDS to improve health care decision making.
But take note of this caveat that accompanies the CMS’s explanation of CDS systems: “We aim to help the healthcare industry create the technical infrastructure needed to allow health systems to share data with each other electronically to provide the most complete information possible into CDS systems. Complete records allow CDS systems to help with diagnoses and track for negative drug interactions by having a better view of a patient’s whole health.”
Bingo. As anyone in healthcare IT knows, that’s one heck of a chasm to cross. The operational and technological barriers the CMS points to have prevented CDS systems from delivering their full potential. However, recent advances in cloud computing, interoperability, big data aggregation, analytics, AI, and APIs have created a perfect storm of innovation that puts the industry on the verge of overcoming those barriers and delivering what was promised for CDSes over 40 years ago.
The CDS Defined
The concept is straightforward enough. A CDS system is any health IT system that’s intended to improve patient outcomes by enhancing medical decisions with timely and accurate clinical knowledge and patient information, at the moment it’s needed. Ultimately, CDS systems should deliver:
- The right information (such as evidence-based guidance or a response to clinical needs)
- To the right people (clinicians who can take action on the information and their patients)
- Through the right channels (such as an EHR, mobile device, patient portal, etc.)
- In the right intervention formats (order sets, flow-sheets, dashboards, or patient lists)
- At the right time (when decisions must be made at points across the care continuum)
That’s a tall order, to be sure. But in the age of Google, Amazon, Apple, and Alexa, these are the kinds of experiences consumers and professionals expect in every aspect of their lives—shopping, travel, media, entertainment—and increasingly, healthcare. It’s an expectation healthcare has failed to deliver on, for five reasons that, thankfully, we can now overcome.
Barriers to Reaping the Potential of CDS Systems
CDS systems need to work seamlessly within established workflows and systems. But typically they’re a separate system that needs to be referred or must be manually integrated and adopted. And those custom integrations can be prohibitively expensive, time-consuming, and brittle when it comes up to updates, upgrades, and change management.
- Data Management and Implementation
CDS systems typically require robust big data management, extensive data curation, and data analytics to be effective. For CDSes to reach their full potential, healthcare data silos (including the EHR) must be toppled, and data from across healthcare systems and settings must be unified and flow freely in real-time. This is typically a tall order.
- User Experience and Design
According to a Stanford University study, CDS development methodologies need mechanisms of iterative feedback, customization, and input from end users, and this doesn’t always happen. Including clinicians’ guidance in the design process measurably improves usefulness and enhances their trust in the system.
- Concerns About Over-Automation
Some clinicians express concern about over-automating the practice of medicine. These concerns are similar to those that arise in other industries, where automation and intelligent agents are being used. The question becomes, what’s the role of the physician in care delivery systems?
- Signal-to-Noise Ratio
Primary care providers get an average of 76.9 notifications a day from labs, pharmacies, and other physicians, according to JAMA Internal Medicine. Adding CDS alerts to all the other alerts clinicians need to review risks the truly critical information getting lost in the noise. That goes double in the midst of a global pandemic, where clinicians are overworked and exhausted, and many are suffering from alarm fatigue.
These five barriers lead to a clinician experience that’s disconnected, complicated, inconvenient and hard to use, hard to trust, and which contributes to physician information overload. Isn’t that the exact opposite of what a CDS system is supposed to accomplish?
The good news is, these barriers can be overcome with a contemporary technological approach. As Dr. Doug Fridsma, former Chief Science Officer of the Office of the National Coordinator for Health IT, put it: “The adoption of electronic health records has created more opportunities to use CDS than ever before. But the key to successful CDS isn’t just data, but rather how it integrates into care delivery. Focusing on the workflow, patient context, and keeping the patient at the center, is the key to successful CDS deployment and use.”
It’s Time to Reboot CDS
What if clinicians had an in-workflow system that could simultaneously improve the speed and quality of the care they give their patients? What if they could receive the right information and guidance, at the right time, at the point of care (not in their inbox later) as part of an integrated care delivery experience? What if CDS systems lived up to their initial promise and actually made clinicians’ lives easier, not harder?
By bringing the power of new technologies—cloud computing, intrinsic interoperability, big data, data activation, advanced analytics, AI, and APIs—to the forefront of the clinical information explosion, the industry can reshape the CDS system by unifying patient data from across siloed healthcare systems, and seamlessly blending CDS into the same workflow clinician’s are already familiar and comfortable with. Instead of giving them yet another application to use, the applications they’re already using get smarter.
“Successful adoption of CDS is limited by the lack of patient context, and that drives alert fatigue,” said Dr. Shobha Phansalkar, Senior Director of Health Outcomes at Innovaccer, and a researcher of CDS alert fatigue. “Leveraging Innovaccer’s Health Cloud brings with it the entire patient context, and that enables CDS systems to improve specificity and actionability.”
See how Roche is using the Innovaccer Health Cloud to topple the five barriers and unleash the promise of CDS once and for all, and help doctors and caregivers improve care quality and patient safety, while keeping them in full control of the care they deliver.