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Clinical decision support tools will include clinical data analytics

Clinical decision support has yet to be widely accepted by physicians. Will future versions of CDS change that trend?

With modern computing capabilities penetrating hospitals and health systems, you would think that physicians are eagerly jumping on board and relying on clinical decision support tools to help them make the best-possible medical decisions for their patients.

Unfortunately, doctors and clinical decision support (CDS) don't mix very well. Doctors are taught to think independently and to be autonomous. They are not taught to rely on external tools or computers when making diagnostic or treatment decisions. After all, if the practice of medicine became heavily dependent on automation, natural language processing, big data analytics, artificial intelligence and robotics, who would need a doctor? Patients would need a technician who could ensure that all the relevant patient information and genomic profiling data were entered properly into the supercomputer, and the machine would do the rest. The machine would diagnose, treat and monitor the patient's progress.

Today's clinical decision support tools are only the beginning. We're seeing the evolution of CDS from version 1.0 to version 2.0, and we'll see versions 3.0 and 4.0 in the not-too-distant future. What will the future of CDS look like? Let's take a look.

The first version of CDS includes rudimentary things, such as medication alerts and allergy warnings. We know that doctors and nurses are suffering from alert fatigue because of all the pop-up windows, bells, and blinking lights inundating them on a regular basis when they try to go about their normal daily routines.

The second iteration of CDS serves more analytic functions and guides doctors to treat patients based on clinical practice guidelines and treatment algorithms. The machine processes data specific to each patient and makes recommendations to help the doctor practice evidence-based medicine and to follow guidelines. This is very important because many doctors deviate from the national guidelines and practice "rogue medicine" because they believe they are doing the best thing for the patient. There are times when deviating from the guidelines could be warranted, but these deviations might not be recognized by payers.

Version 3.0 of CDS will include natural language processing and big data analytics at the point of care. What this means is that while the patient is speaking with the doctor, the machine will listen to the conversation, process all the information, and make diagnostic and treatment recommendations before the doctor has concluded the visit. The machine already will have processed all the possible clinical scenarios and run them through predictive analytic models. The summarized data will be presented to the doctor before he concludes the visit with the patient. By this time, automation will have replaced manual data entry.

So, where does that leave CDS 4.0? That's when the robots take over. Robotic surgery is still very manual, but automation will slowly incorporate itself into routine operations. Much of the doctor's job will be performed by supercomputers that are able to integrate relevant data with health IT systems. The days of interoperability challenges will be long over. Machines will be ready to take over hospitals in CDS 4.0. Automated robots will deliver food to patients. They will transport patients from the waiting room to the CT scanner. Robots will review discharge instructions when patients leave the hospitals. Robots will accompany patients home to help them with home care instructions. Some of these things are already happening today, and a number of hospitals are successfully incorporating both manual and automated robots into the healthcare delivery system.

The journey from CDS 1.0 to CDS 4.0 might sound futuristic, but consider how rapidly technology has evolved over the past five years. The first Apple iPhone was introduced in 2007. Do you remember how you used mobile technology in the era of the Palm Pilot or the Treo? Technology is evolving and the days of CDS 3.0 and 4.0 are not too far away.

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

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