Thursday, September 15, 2011

The Importance Of Evidence In Providing Quality Clinical Care. Getting This Right Can Possibly Make More Difference Than the Proposed PCEHR.

This appeared a few days ago and is really germane to the current PCEHR discussion.

Clinical Decision Support Closes Medical Evidence Gap

Best practice data is available for most healthcare decisions, but health IT teams are doing a lousy job of getting it to doctors, says Ascension Health informatics chief.
By Neil Versel,  InformationWeek
September 08, 2011
If Meaningful Use of electronic health records is ever going to fulfill its promise of better care at lower cost, clinical decision support (CDS) systems had better play a central role delivering relevant medical evidence to the point of care, according to one veteran informatics physician and patient safety advocate.
"The evidence of best treatment, if not the right treatment, is available probably 85% of the time," Dr. Jeffrey Rose, VP of clinical excellence and informatics at St. Louis-based Ascension Health, tells InformationWeek Healthcare. Unfortunately, information is not often readily accessible.
This opinion runs counter to a widely cited statement by Kaiser Permanente's Dr. David Eddy that just 15% of medical treatment is supported by scientific evidence. "That's old and wrong," according to Rose, a former chief medical officer of EHR vendor Cerner. "When you do further studies, information is available, it's just not in the clinical environment."
It's also been widely cited that it takes 17 years for new medical evidence to find its way into practice. By the time that happens, the evidence could be outdated. That, according to Rose, is symptomatic of practicing without computer assistance. "The overarching problem is that doctors cannot possibly update their knowledge as fast as the evidence changes," Rose said, echoing sentiments that medical informatics pioneer Dr. Larry Weed has been expressing for half a century.
That's where IT, in the form of CDS, comes in. "It's critical in being able to fill in that gap," Rose said. According to Rose, CDS really has three components, and they are not always used together.
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There are two reasons for raising this right now. The first is to note that in the recently released Finalised PCEHR ConOps that Clinical Decision Support is the very last on the list of proposed enhancements to the PCEHR System (See Page 28).
The second is to point out that a real evidence based intervention of making currently available clinical literature available via a Government Sponsored Portal - as mentioned in the Deloittes Strategy of 2008 is still being ignored. It is only with solid current clinical information can be make any difference in the adoption of improved clinical practice within the medical (and other clinical) professions.
As far as I can tell it is planned that the consumer portal will provide some user education features but for some reason this does not seem to be planned for the provider portal. Why that would be just eludes me!


Anonymous said...

A common opinion is that the provider portal will not be used widely. Most clinical systems will (sooner or later) build a gateway/portal to the PCEHR so that the GP, etc can see all the data integrated into their desktop.

One this is done (an the data is atomic) then the clinical system can use the information that is available both locally and via the PCEHR to do decision support.

I agree that decision support is important. I disagree that the PCEHR should be providing this. The PCEHR should be providing (some) of the data that is used by a separate CDS system or systems.

Further, do we really want the PCEHR to be an education too? There is already existing processes and infrastructure to provide this.

Dr David More MB PhD FACHI said...

Maybe I was not clear enough. I don't actually care if the professional knowledge resource is part of the PCEHR as long as it is actually provided. It was part of the national strategy, is evidence based, would not cost much (comparatively) and might help value be extracted from the NBN.

A no brainer to me - no matter where housed.