A 2008 study on CDS (clinical decision support) tools found that while the benefits of CDS technologies are widely understood and accepted by providers, there is still a lack of proactivity in its adoption. An article summarizing the study stated: “For example, Chang said that while CPOE with CDS is now already widely accepted, it is rarely used appropriately.” Physicians complain that too many inappropriate alerts pop up on the computer screen, and as a result, providers begin to ignore the alerts, negating the reason why they were set up in the first place. Chang also cited a general lack of technology adoption and steep financial investment as high barriers to adoption. “If Facebook is able to predict who an individual might be friends with based on who he/she is already friends with, why shouldn’t CDS be able to determine what diagnosis patients may have based on their health information?” she asked.”[1]
The problem with this analysis is that Facebook cannot be sued if members become friends with the wrong people but physicians can be sued for malpractice if a patient is incorrectly diagnosed and treated, especially if that treatment turns seriously negative for the patient. Medical practice and treatment should not be subjected to as simple a comparison. Even if a CDS tool can be accurately set up to flawlessly diagnose patient symptoms, it cannot replicate the personal touches of a physician who can answer patient’s questions while performing a check-up. For example, a patient can go to a podiatrist for a foot problem and also be able to get a prescription for eczema cream without having to see two doctors at two different times and pay two different co-payments. The patient can speak to the doctor about his/her eczema or other minor ailments while the doctor is checking his/her foot. If the point of new technologies is to ultimately improve healthcare, then how will a CDS tool that diagnoses patients without seeing a doctor help in this commonly occurring situation? If the patient can still see and speak directly with a physician, why should he/she spend time on a CDS tool as well?
Fast forward four years and here is where we are today: “A 2009 Black Book EHR survey found that 88 percent of provider organizations believed their EHR vendor would meet most of their interoperability and foreseeable clinical information needs. However, in 2012, fewer than 10 percent have the same expectation of their EHR system.”[2] Why? The reasons are plenty.
Providers do not feel equipped to hire and train qualified candidates who can become experts in specific CDS tools to make enough improvements in the delivery of care. However, according to the same 2009 survey by Black Book, 69% of larger hospitals feel “technologically equipped” to handle the changing healthcare environment. Also, more and more providers are now focusing on gathering business intelligence on the care they provide before adopting technologies to change its delivery. CDS tools that make generating and presenting this business intelligence easier are needed more than others that can auto-diagnose patients, etc. Business intelligence tools can give providers the information needed to determine whether more sophisticated tools are necessary or the clinical workflow simply needs to change to improve the delivery of care and the revenue stream.
Before we pile on more CDS tools that may not improve delivery of care and the health of patients, proper information is necessary to determine whether such tools are even needed. For example, EHRs as a CDS tool can improve the delivery of care. The next step should be to gather data from EHRs to generate intelligence on diagnoses and treatments, and then decide whether more sophisticated CDS tools are required in these areas. We are only now entering the era of EHR business intelligence.
[1] Pizzi, Richard. CDS Tools Can Change Medical Practice. http://www.healthcareitnews.com. August 01, 2008.
[2] McCann, Erin. Clinical Analytics Next Big Thing for Health IT. http://www.healthcareitnews.com. August 01, 2012.
