Clinical Decision Support: Right Approaches Ensure Improved Clinical, Cost, and Efficiency Gains

Clinical Decision Support: Right Approaches Ensure Improved Clinical, Cost, and Efficiency Gains

Steven Shaha (Center for Policy and Public Administration, USA)
DOI: 10.4018/978-1-5225-2237-9.ch033
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The purpose of healthcare information systems should tend toward helping clinicians make best decisions for the clinical benefits of their patients, as well as for the cost-related benefits of organisations, communities and societies. Too many healthcare organisations are opting toward technology-based systems that ensure cost-effectiveness as a priority over clinical quality, limiting clinician decisions toward compliance to established decisions and processes rather than toward innovative and impactful approaches to patient care. Compliance-based solutions assume that all hospitals are identical in populations served, clinician expertise or physical layout, all assumption fallacies. Best healthcare enhancing technology enables local adaptation with analytics for ongoing innovation to best optimise successes in care quality, cost-effectiveness and efficiency. Such systems are available, and best providers will encourage clinicians and operational leaders to ever-improve delivery of innovative, evolving health care. This chapter will discuss the right approaches towards improved clinical, costs, and efficiency gains.
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Among the greatest travesties in modern healthcare is the wrongful use and definitions of the term “clinical decision support.” The description is routinely applied to sub-optimal systems that offer clinicians virtually no support in making decisions, having been designed primarily for other purposes. Often computerisation has been implemented principally to gather data for charging and business purposes, and not for helping any clinician make best decisions for clinical or care-related purposes. Yet, apparently in an effort to either appease or entice clinicians to higher adoption, the label of “clinical decision support” is attached (Chaudhry, 2006)

The summary bottom line is simple: The purpose of healthcare information technology, particularly electronic medical or health records (EMRs/EHRs), remains to enable and empower clinicians to make best decisions for care, cost and efficiency actively and in real time. That is best labelled as Clinical Decision Support, or CDS. Any alleged solution that minimises either the “clinical” or “decision” portion of CDS should responsibly re-label their CDS approach as “Compliance Driving System.” EMRs/EHRs should be more than mere storage and retrieval mechanisms, and should leverage the ability of computers to compute, monitor and advise (c.f. Kawamoto 2005).

The purpose of this chapter is to describe the subtle differences in the contrasting approaches to CDS within healthcare information technology (HIT). HIT solutions, particularly within EMRs/EHRs, and make clear the downsides and benefits to alternative approaches.

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