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.
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happens, the evidence could be outdated.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.
Learn more
here:
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!
David.
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.
ReplyDeleteOne 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.
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.
ReplyDeleteA no brainer to me - no matter where housed.
David.