Evolving Clinical Decision Support: A Guide to Discovery-Driven Transformation in Healthcare


Over the past few years, the healthcare landscape has seen dramatic changes: increased demand for caregivers, changes in care settings (especially post-pandemic), and new technologies, just to name a few. These evolutions are impacting how clinical decision support resources and tools are designed and delivered.

Sheila Bond, Ph.D., a physician specializing in transplant and infectious disease services at Brigham and Women’s Hospital and editor of UpToDate®, said in the Scottsdale Institute’s webinar “Clinical Decision Support” that the scientific evidence He talked about the challenges and modern best practices in developing resources based on . Evolving healthcare workers. This presentation was sponsored by Wolters Kluwer Health.

Health care and the way it evolves is at “a tipping point in many ways,” Bond said in a webinar where changing circumstances will affect how knowledge and guidance are and will be provided to clinicians. told the participants.

Building knowledge differently for changing care environments

Bond examines several key system-wide changes underlying the development of clinical decision support (CDS) resources.

  • Changes in who makes care decisions
  • More choice and variety in how and where to see patients
  • Increased demands on clinicians
  • New Priorities in Educating the Next Generation of Clinicians

“It’s changing who makes decisions about the health of others in the United States,” Bond said. Throughout most of America’s modern history, doctors have been the primary decision makers when it comes to diagnosing disease and prescribing treatment. She cites research in the New England Journal of Medicine that predicts that by 2030, advanced clinicians, such as nurses and physician assistants, will be the first patients to come into contact with the health system, especially in ambulatory care. points out that it is more likely that Sky. “This has created an impetus and need for a greater focus on healthcare across teams and teamwork.”

Like the change in “who,” Bond notes, “where” constitutes a big change. More and more patients are being treated through emergency care settings, retail pharmacy clinics, virtual care telemedicine settings, or home health care instead of hospitals. A traditional brick-and-mortar hospital.

Understanding the needs of these users and settings and providing decision support information is essential going forward.

Increased demands on clinicians

Clinician burnout has been an industry concern for some time, Bond said, and as patient complexity continues to increase, the demands on clinicians have never been higher. she said:

  • Studies show that while patient numbers are aging and increasing in complexity, physician contact time with each patient has stabilized at an average of 16-17 minutes.
  • “The amount of data we need to absorb during our time with individuals is also increasing,” says Bond, but studies show that “we are spending nearly as much time on electronic medicine these days as we are on patients. and spends” records. “
  • “The amount of medical information that must be scrutinized in order to implement appropriate care is increasing at an alarming rate,” she says. One study estimates that she doubles every 73 days.

A CDS should meet these needs and act as a time-saving tool to consolidate critical information rather than as an additional burden.

New priorities in medical education

The need for medical education has a direct impact on the development of CDS, Bond notes. “I think we are doing very well at CDS when it comes to the traditional core competencies of physicians, medical knowledge, and evidence-based medicine. These have been core to our curriculum for many years. But as these changes take place, there is an equal or even greater focus on the other skills we need for the next generation.”

These include:

  • Cross-professional communication
  • Patient-centred care and the ability to “pull the patient into care”
  • Social Determinants of Health and ‘How to Incorporate Them into Decision Making’
  • Facilities with technology and digital literacy

“While we are equipping the next generation with the skills they need, we also anticipate that there will be providers with new skills that we need to support through our work and content creation,” Bond said. .

Navigating the transformation of clinical decision support in healthcare

While adapting to changing circumstances as audiences, structures and needs evolve, the core of CDS remains the same. It starts with what Bond calls “her five rights in the CDS.” We want to make sure the right information gets to the right people at the right time, through the right channel, in the right way.

While the right formats and channels are essential to ensuring that information is encountered and made available to health care professionals, Bond said, “When these mechanical factors take precedence over the information itself. I believe that it is not just the physical or mechanical act of getting information where it is needed, but how it is portrayed, the tone and spirit of the exchange, that makes a big difference in the world. is thinking.”

She views CDS development through four categories: information delivery and discovery.

  1. forced detection
  2. encourage discovery
  3. Guided discovery
  4. Discovery at the Frontier

Four Kinds of Discovery: From Engaging Clinicians to Unlocking AI Potential

1. Forced Discovery: Leveraging Data to Make Informed Decisions

An example of forced detection is best practice alerts. “It’s something that can follow these five rights,” says Bond. “And it’s very simple, and when used at the right time and in the right amount, it’s a very effective intervention.”

While CDS alerts in clinical workflows are intuitive, Bond admits that problems can arise. “It’s siloed. Putting a little bit of information in the right setting solves the problem. But it can also be very annoying, especially if it’s delivered in bulk.”

The challenge with CDS is to “get the balance right” between the information you want and the intrusion. Bond believes balance can be found in tracking engagement and performance metrics. “Are individuals engaging with this particular alert or this particular format?” If you can’t engage your audience, I think you’ve fallen through that gate too. Once you get engagement, do you want that alert to actually change the outcome you want?”

2. Encouraging Discovery: Innovative Knowledge Accessible to Healthcare Professionals

Bond defines recommended findings as “something like UpToDate or other trusted references” that can be integrated into clinical workflows. They don’t intrude or interrupt your workflow like forced alerts do, but the encouraged resources are readily accessible at key moments, increasing the chances of them being encountered while working. increase.”

“This concept has been in the medical community for some time in terms of spontaneous interactions, and we want to encourage it,” she explains.

3. Guided Discovery: Can we streamline collaboration and learning in healthcare?

Bond points out that many clinicians, at some point in their career, have come across a genius whose accumulated knowledge and experience has given them a unique ability to solve the most complex medical puzzles. I’m here. These individuals are natural resources for learning and guided discovery.

These Best Teachers “Teach You Step by Step” Through Instruction [puzzles] By asking what you think and what you see. And it was as if I had finally figured it out on my own,” says Bond. “Not only did you walk away from those encounters with a concrete answer to the problem you were dealing with, you formed a new paradigm on how to solve the problem logically. I understood it so much that it became mine, and I could pass it on to others.”

The challenge for CDS, she says, is to incorporate such guidance into “electronic specimens.” It may not be possible to reproduce, but as an inspirational guide in creating clinical pathways and other content and decision support tools, consider the best interests of your patients and those of your patients. It is intended to provide step-by-step guidance. mind. “

4. Frontiers: Unlocking the Potential of AI in Healthcare

“The question everyone is thinking about in healthcare is how do we dance with ChatGPT and what does that mean for us? says Bond.

The future of AI in CDS and other medical applications is still new ground, she says. It’s an incredibly easy experience to just ask the question you care about and get the answer back in the format you want. “

Bond also describes AI’s “boldness”, especially in the area of ​​medical knowledge. Too many alerts. Knowledge is destroyed. You have to go to so many places to find the answer to your question. You can never be sure that you have achieved everything. She admits to admiring AI’s “think big” approach, which allows her to cover fragmented and broad medical knowledge bases with a single search, but that the technology’s inherent It also warns about limits.

“This is not a proxy for that skilled clinician,” she says.

Empathy with clinicians and their needs

Whatever the future holds for medical knowledge and medical technology, Bond says when designing content for CDS: I always see it as the top problem I’m trying to solve. “

She explains that her role as a content creator is to support clinicians’ decision making. Success begins with empathy for users who are happy to work in an increasingly complex and demanding environment. She focuses on holistic solutions and whether the content she creates is “consumable in that environment.” To be successful, the information must be accurate, but “it’s no small thing.”

To be effective, she explains, users need to work with that information. “Will someone get that information? Do they want to play with it? Do they want to play with it? Do they want to use such a format? I learned The thing is, the first principle of the highest order is always empathy for the individual who needs to use the object.”



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