The challenge

Quality, cost and the rise in long term conditions are forcing all healthcare providers around the world to reassess how services can be delivered more efficiently and effectively. Most have concluded that whilst technology is not the only answer, it is invariably part of the solution.

As the health service reforms place pressure on both quality of performance and “doing more with less”, processes and procedures need to be evaluated to ensure they are delivering efficiencies without compromising on patient care. It is therefore now more crucial than ever that the clinical decision making process results in the best outcome for the patient in the shortest possible timescale. Both QIPP and the “Right First Time” initiatives have components which are associated with learning from the experience of others and delivering quality patient care. Evidence-based clinical decision support is at the heart of all these programs.

There are four key functions of clinical decision support (as outlined by Perreault & Metzger, 1999):

  1. Administrative: Supporting clinical coding and documentation, authorization of procedures, and referrals.
  2. Managing clinical complexity and details: Keeping patients on research and chemotherapy protocols; tracking orders, referrals follow-up, and preventive care.
  3. Cost control: Monitoring medication orders; avoiding duplicate or unnecessary tests.
  4. Decision support: Supporting clinical diagnosis and treatment plan processes; and promoting use of best practices, condition-specific guidelines, and population-based management.

Clinicians need a trusted, high-quality source for evidence-based clinical information and treatment recommendations. While many doctors routinely use general search engines to answer clinical questions, the quality of information they offer is varied. Clinical Decision Support software is not a replacement for the clinician but a tool to support them and other health professionals in diagnosing and identifying appropriate care pathways. The sheer volume of new medical information that becomes available on a daily basis is staggering, and extremely difficult to stay on top of, therefore clinical decision support helps reduce the existing gap between evidence-based knowledge and health care practice.

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