Clinical Decision Support: Data You Can Use Today

During a typical shift in early 2014, a patient presented to the emergency department at Brigham and Women’s Hospital suffering from shortness of breath and chest pain severe enough that doctors considered it may have been a pulmonary embolism — a potentially fatal blood clot in the lung. The patient was pregnant, forcing Jonathan M. Teich, M.D., to make a fast decision: Go with the standard CT scan with contrast and risk radiation to the fetus, or try another test that may miss the diagnosis.

Historically, a physician faced with this dilemma would need to dig up a paper or book on the subject, which, if even accessible, might be a few years out of date. “There would be information out there that says this test is better than that test in this circumstance, but I would have to go out and find it,” explained Dr. Teich, who is also chief medical informatics officer of the health sciences division of Elsevier Publishing. “And chances are, because it takes time and because it takes me out of my game, I might not do it.”

Vital Signs May 2014 - Dr. Teich
Jonathan Teich, M.D.

Fortunately, Dr. Teich didn’t have to guess about the best way to diagnose his patient. “As I go to the order set while I’m writing orders, which I have to do anyway, embedded in my work flow is a decision tree and the information is right there, explaining in this circumstance to do this ultrasound first and what to do next if it’s negative,” he said.

This is just one example of how clinical decision support tools can supply doctors with fast access to clinical information that commonly applies to specific cases, helping them make the best decision without breaking stride.

At the MMS annual meeting from May 15 to 17, Dr. Teich and other expert faculty will present the educational program, Data-Driven Clinical Decision Making and Improving Quality of Care. The program will describe various ways these tools can benefit physicians in their everyday practice, along with plenty of first-hand advice about how to implement clinical decision support effectively, without information overload or workflow disruption.

Individualizing Care

Vital Signs May 2014 - Dr. Kohn
Martin Kohn, M.D.

In addition, attendees will learn about how decision support systems can help them provide more individualized care, said presenter Martin Kohn, M.D., chief medical scientist at Jointly Health. “The other goal for the transfer of information in healthcare is to make more personalized decisions that are specific to the individual patient,” he said. “Not all diabetics are the same, for example. There are unique characteristics of every patient that might mean their management should be different from the typical. Precision medicine means we’re going to make better use of all of the kinds of information that are available to us to gain the insights we need to make those personalized decisions.”

Part of making clinical support work for you is choosing the correct tool, noted Dr. Teich, who co-authored the book, Improving Outcomes with Clinical Decision Support: An Implementer’s Guide. According to the book, these are the 10 different ways clinical decision support can be presented to users:

  • Immediate Alerts (after orders and prescriptions)
  • Event-driven alerts and reminders (e.g., after test results come back)
  • Order Sets, Care Plans, and Protocols
  • Parameter Guidance (patient-specific dosing)
  • Smart Documentation Forms
  • Relevant Data Summaries
  • Multi-patient Monitors and Dashboards
  • Predictive and Retrospective Analytics
  • Filtered Reference Information and Knowledge Resources
  • Expert Workup Advisors (artificial intelligence programs)

Different types can be useful in different situations, said Dr. Teich. For example, filtered reference information may be very useful when you are first working up a new patient with an unfamiliar set of symptoms and signs, whereas order sets can be useful when you have an overall game plan but want to make sure you get all the details right and not forget important things to do.

Overcoming Myths and Challenges

One of the first challenges in realizing the benefits of these technologies, however, is in overcoming misconceptions about the purpose of clinical decision support. “It can be a somewhat threatening or contentious subject,” said Dr. Kohn. “Some people describe clinical decision support or using data analytics as an effort to force physicians into cookbook medicine, take away their autonomy, or compensate for the incompetence of physicians.”

These are all flawed assumptions, he said. In contrast to 40 years ago when just getting the clinical information one needed was a challenge, today anyone can go online with a search and get 100,000 hits in a tenth of a second. “The environment has changed,” Dr. Kohn said. “We now have access to huge amounts of information that exceed our ability to process, understand, and use.”

Most importantly, physicians should understand that these tools offer decision support, not decision making, added Dr. Teich. “It’s not an expert commander saying this is what you do. It’s kind of like a really conscientious medical student who says, ‘Hey, I just read this paper and here’s some info that might help.’”

Finally, Dr. Teich says that physicians’ fears that clinical decision support tools increase their malpractice risk are unwarranted. “We often hear general concerns in which physicians ask, ‘If I have a decision support tool, does it make me more liable if I do or don’t do what it says?’” he explained. “What the wisdom seems to show from experience is that people hold you responsible for doing the right thing, regardless of where you got the information from.”

Most often, organizations reduce their malpractice risk by implementing decision support tools, he added.

Overall, these experts are aiming in their presentation to help physicians recognize the practical value of clinical decision support. “Some of the things you are already doing are a form of decision support, but there may be ways to do it better,” Dr. Teich said. “Our overall goal is to help you practice with the greatest quality, safety, and, cost-effectiveness as possible, and this is one important tool that can make a difference.”

For more information about the 2014 MMS Annual Meeting from May 15 to 17 at the Seaport Hotel and World Trade Center visit www.massmed.org/annual2014.

—Debra Beaulieu-Volk
MMS Staff Writer

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