Full disclosure: I am not a doctor.
Okay, with that truth bomb out of the way, I feel safe to go ahead and write about the subject of clinical decision support (CDS) openly. I understand there is a considerable amount of skepticism and annoyance when it comes to patient safety alerts, alert fatigue, and clinical decision support systems within the electronic health record (EHR). The terms are intermittently linked and often it’s not in a positive light for the whole notion of CDS.
For instance, take this study from June issue of Pediatrics, which looked at the case of a young child being treated at Stanford University’s Lucile Packard Children’s Hospital. I won’t get into the details, but thanks in part to unnecessary clinical allergy overrides that came from alert fatigue, the child died (there were other complications). The study’s authors said that it was dangerous to burden clinicians with unnecessary alerts and that many of the systems didn’t include up-to-the-minute clinical information
There have been other studies deriding CDS tools because they weren’t properly integrated into the clinical workflow or because certain systems weren’t properly customized to get rid of drug–drug interaction (DDI) alerts that were overridden 90 percent of the time. Heck, there was even a study, from researchers at the University of Missouri, which found that even patients said using CDS was a turnoff in a physician. All this leads me to believe that the association with alert fatigue has led many providers to roll their collective eyes at the notion of current CDS systems.
Quite simply, I don’t think idea of CDS is winning any popularity contests these days.
There is, however, one physician who is a big-time advocate for CDS, and his name is Jonathan Teich, M.D. Dr. Teich is the CMIO at Elsevier, Philadelphia-based healthcare information and software provider, and a practicing emergency physician at Brigham & Women’s Hospital in Boston.
Knowing his advocacy for CDS (he wrote a book on the subject), in a recent interview with Teich, I asked him about the CDS-related critiques, particularly when it comes to alert fatigue and integration into the clinical workflow. Here’s how he responded, almost verbatim, because I think it’s an important defense of an area that seems to faces misconceptions:
We need to realize that CDS involves far more than alerts. CDS embraces many other methods, including intelligent data displays and intelligent knowledge delivery. To that point, CDS can offer clinicians insight into the questions we tend to ask most: What do I really need to know about this patient? What do I need to do next? Am I taking the best, most appropriate action right now? Over my last 500 patient encounters?
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