At a recent affiliate meeting, I was asked the question about “clinical decision support” tools within EHRs and it’s role in “doing our job for us.” This reminded me very briefly about the introduction of computers into the marketplace. There was immediate concern that people would be replaced by computers and that technology would have an detrimental effect on the employment situation in the United States. In reality, some functions and work processes were assumed by technology, with the resulting impact being that humans took on higher skilled jobs (which paid more!)
The Agency for Healthcare Research Quality published a great piece on Electronic Health Record Usability: Evaluation and Use Case Framework in 2009. In this report, the authors identify four areas of expected EHR Tasks:
1. Memory (and not in the usual technical sense!) The EHR provides demographic and other pertinent data which we do not have to put to memory. It prompts us for any missing information that is critical to the care of the patient.
2. Computation Having grown up in the hardbound “Bowes and Church” nutrient analysis world, where nutrient analysis involved fine print, columns and rows, pencils and a calculator, this is a powerful tool for me! The EHR also can provide reference values and ranges based upon age, gender and health condition. The list goes on.
3. Collaboration Not that we couldn’t do this before EHRs, but the logistics always got in the way. Now we can (if the work flow is appropriately developed) communicate clinical data across providers and with patients more efficiently and accurately.
4. Decision Support—At last!! The whole reason for this blog! While I suppose one could create a decision support tool that had most every algorhythm for decisions based upon clinical findings, it has to be utilized with human intervention and logic. In the words of the authors, this tool can be used to:
- Recommend care based upon patient characteristics.
- Act on oriented clinical reminders
- Support based upon outside recommendations/research
- Evidence based care can be adjusted by patient conditions
- Alignment with insurance requirements
- Identify interactions, contraindications and effectiveness
In short, decision support helps us assemble all of the components – but does not “think for us”. Decision Support within EHRs should include nutrition and allow for decisions that the patient and provider make together based upon the best possible outcome.