A concept in informatics which has received a good bit of attention recently is that of “clinical decision support.”
While there are multiple definitions, here is the one from our great friends at the Health Information Management and Systems Society (HIMSS) http://bit.ly/bQJtDa
“CDS is defined broadly as a clinical system, application or process that helps health professionals make clinical decisions to enhance patient care. Clinical knowledge of interest could range from simple facts and relationships to best practices for managing patients with specific disease states, new medical knowledge from clinical research, and other types of information.”
Most of the discussion for CDS has been based upon medication choice and administration. For example, if a patient has diabetes, congestive heart failure, and high blood pressure, which medication would likely work best and inflict the least side effects?
Little research to date has focused on inclusion of a “consumer controlled” choice for desired outcomes or any inclusion of evidence-based nutrition care. The intent is not to provide all the answers via an electronic means, but rather “suggest” best practices. My favorite example to use is a simple one: It is well documented that weight loss (sometimes as little as 10-15 pounds) will help reduce blood pressure. If the “decision support” nudged the provider to consider offering the patient an option to “lose weight” (with RD guidance of course!), prior to starting medication—perhaps the long term side effects of blood pressure medications could be lessened. There will never be a “one-size-fits-all” design that works—but it would allow the patient to take a more engaged role in their own care.
I recently had a comment from an RD after I sent a survey inquiring about CDS. I would be interested in your thoughts, any experience in this area, and/or ideas.
“All RD's have years and years of education that should not be placed in a computer… to be computerized and told what to do... Medicine is not an exact science. People are not an exact science. Science is for study not for stagnant theory, instead we want reality theory where we can use our brains and exercise our right to think of new ways of doing things.”