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Clinical decision support tools still underused by clinicians

A major challenge facing today's physicians is learning how to complement their wisdom and experience with clinical decision support technology.

The concept of clinical decision support has been around for many years, but the active adoption of it continues to vary among physicians. There are some physicians who feel clinical decision support can be too narrow and prescriptive. They use the term "cookbook medicine" to imply that healthcare providers who stringently follow algorithms and clinical pathways are not using their brainpower to apply the art of medicine when they care for patients. Instead, they are following rigid recipes based on established guidelines, many of which are outdated.

A wide variety of clinical decision support tools, both of the simple and advanced variety, have been integrated into EHR systems. Physicians and hospitals -- already struggling with alert fatigue -- are getting bombarded with clinical messages and pushed to continue to use more sophisticated clinical decision support tools.

The expectation is for clinicians to use clinical decision support at the point of care when they are actively treating patients. Some advanced clinical decision support tools are seamlessly integrated into an EHR and become a natural extension of the clinical workflow without hindering productivity. Other clinical decision support tools are intrusive and distracting, and they end up becoming useless because clinicians choose to ignore them.

The practice of medicine is both an art and a science.

Most physicians did not use EHRs when they were medical students. They did not learn how to apply clinical decision support tools at the point of care when they were going through their clinical training. The American Medical Association is hoping to change this through their "Accelerating Change in Medical Education" initiative, which consists of 11 medical schools piloting innovative approaches to educate medical students. Several of these projects incorporate the use of EHRs, virtual patients, and the application of clinical decision support as medical students treat real and virtual patients and document their progress on EHRs.

As medical students learn to naturally use EHRs and clinical decision support tools when they treat patients, they will be more efficient at using the technology once they enter the workforce as practicing physicians. They will also have the ability to offer valuable feedback to shape and improve EHRs and clinical decision support.

There are so many ways technology can be used to improve patient safety and the delivery of care, but growing patient workloads has left many physicians struggling to efficiently utilize EHRs during clinical encounters. Physicians who rely on medical scribes to enter information into EHRs don't see the visual cues and alerts generated when data is entered or selected in check boxes or drop-down lists.  There are hospitals still trying to establish consensus around prioritizing clinical alerts and messages so that physicians are not overwhelmed by them.

Clinical decision support tools are designed to improve patient safety and encourage physicians to remain concordant with established guidelines. However, physicians often deviate from recommendations because of unique patient factors or other circumstances that justify alternative treatment options. For instance, when a patient develops advanced cancer and chooses non-aggressive medical care and symptom management instead of chemotherapy and radiation therapy, the treating physician and team of clinicians may need to deviate from standard treatments in order to respect the patient's wishes.

However, the treating physician may choose a radically different approach to manage symptoms for a certain this patient. Should disruptive alerts and messages pop up on the screen every time the physician is trying to prescribe a treatment that goes against clinical guidelines?

The practice of medicine is both an art and a science. As clinical decision support becomes an integrated part of clinical medicine, physicians will need to learn how to modify their workflows so clinical decision support moves from being an annoyance that disrupts it to an instrumental tool that helps them deliver better care.

About the author: 
Joseph Kim is a physician technologist who has a passion for leveraging health IT to improve public health. Dr. Kim is the founder of and is an active social media specialist. Let us know what you think about the story; email [email protected] or contact @SearchHealthIT on Twitter.

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