Clinical Decision Support Closes Medical Evidence GapClinical Decision Support Closes Medical Evidence Gap

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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 information 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 By the time that happens, the evidence could be outdated.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.

The first is what Meaningful Use is supposed to provide, namely using EHRs and health information exchange to deliver all relevant information on a given patient to clinicians at the point of care.

The second part, Rose said, includes recommendations from the medical literature and access to those recommendations. In other words, what treatments have the best chance of working, and how do they apply to the patient in question? (For the purpose of Meaningful Use, the federal government calls these "evidence-based care sets," which is what Ascension has at many of its hospitals, according to Rose.)

Third, as CDS is defined in the Meaningful Use regulations, is the use of those recommendations based on algorithms and reminders specific to each patient.

"Overall, we want to be using all three kinds of clinical decision support," Rose says. "Meaningful Use is all about getting people on these three platforms."

Find out how health IT leaders are dealing with the industry's pain points, from allowing unfettered patient data access to sharing electronic records. Also in the new, all-digital issue of information Healthcare: There needs to be better e-communication between technologists and clinicians. Download the issue now. (Free registration required.)