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Provider organizations must overcome numerous obstacles to expand the use of decision support systems.
When University Health Network was implementing a clinical decision support system, it assumed that physicians would be the chief roadblock to success, says Robert Wu, M.D., who spearheaded the process.
Physicians often balk at using clinical decision support systems, which use evidence-based, "best practice" guidelines and alerts to recommend drug and medical treatments. A recurring complaint is that the applications dictate treatments and hinder physicians when they're trying to deliver personalized care to their patients.
Much to Wu's relief, however, the 700 physicians at the three-hospital, Toronto-based delivery system embraced the decision support application. Resistance disappeared in large part thanks to an I.T. clinical advisory committee that provided physicians a forum to air their concerns about evidence-based guidelines and recommend ways to fold the decision support system into their workflow processes, he says.
The battle, however, was far from over. Physicians routinely used the application to ensure they were ordering lab tests recommended by an advisory committee for patient conditions. However, University Health had a hard time creating automated guidelines and alerts due to the dearth of evidence-based research.
In addition, it had difficulty evaluating the effectiveness of adhering to the guidelines. And without evidence the decision support application was improving care, physicians in the future would be loath to change their practices based on recommendations from the software.
"There isn't a lot of information on how to modify and promote best practices," Wu says. "So we're constantly reevaluating our guidelines and creating new rules in the decision support system to get the best results."
What's it all about
In general, the term "decision support" refers to applications that analyze patient data and provide recommendations and alerts based on drug and treatment protocols.
Some organizations use a broader definition for decision support. To them, the term "decision support" encompasses applications that analyze clinical, financial and administrative data to help develop guidelines for care delivery as well as administrative functions such as staffing levels.
Because the clinical decision support applications often are perceived as "cookbook" solutions to complex medical problems, provider organizations usually anticipate physician resistance-and physicians usually don't disappoint. Still, many organizations have found physician resistance is but one...