In today’s dynamic health care environment, particularly in the post-pandemic era, clinicians are continuously striving for excellence in patient care, whether it’s delivered virtually or on premise. However, amidst organizational and economic hurdles, they face mounting pressure due to the escalating demands of an expanding patient population. This, coupled with the challenges of maintaining a healthy work-life balance and sustaining peak performance, often leads to burnout, depersonalization, and stress among dedicated health care professionals. This situation is neither sustainable nor conducive to providing optimal care.

To address these growing challenges and support the well-being of health care providers, forward-thinking, technology-focused organizations such as Providence’s Virtual Care and Digital Health, have partnered with health care professionals to develop innovative solutions, setting the bar for care excellence. Among these solutions are clinical decision support systems (CDSS) which are designed to streamline and enhance the delivery of care virtually and in person.

Despite the challenges and initial reluctance, integrating CDSS into clinical workflows holds the promise of optimizing patient outcomes and improving overall health care quality.

Developed to assist providers in delivering the best care for their patients, a CDSS is an electronic health information tool that provides clinicians with recommendations and treatment pathways. Access to this tool enables providers to make informed decisions about patient care without needing to refer the patient to another provider, which can help minimize patient dissatisfaction. Unlike traditional care diagnostic methods, which often require clinicians to specialize in a particular ailment or immediately refer patients at the onset of an illness, CDSS empowers providers to assess real-time options and choose the most appropriate course of action.

Recognizing the critical need and immense benefits of CDSS in revolutionizing health care delivery across the entire continuum of care, Dr. Eve Cunningham, a visionary leader and esteemed clinician, has spearheaded a groundbreaking initiative. With her innovative approach, she not only envisioned but also implemented a cutting-edge CDSS platform designed by clinicians to support providers in their clinical decision-making processes. “This cutting-edge CDSS platform offers specialist-level clinical expertise and just-in-time support to front-line clinicians while they are in the context of a virtual or in-person visit,” says Dr. Cunningham, “[which] translates to happier providers and improved patient access.”

By leveraging this cutting-edge CDSS platform, Dr. Cunningham seeks to optimize patient care outcomes, enhance efficiency and streamline workflows through leveraging artificial intelligence (AI), thus ushering in a new age of transformative health care delivery.

While a CDSS holds immense potential to enhance the efficiency of care delivery, particularly in resource-constrained clinical environments, its widespread adoption has historically been hindered by various challenges. These obstacles include excessive documentation burden on providers, clinician reluctance stemming from a lack of confidence in the system and negative patient perceptions.

Many clinicians, for example, have found themselves overwhelmed by the sheer volume of alerts generated by certain CDSS platforms, which can impede their ability to focus on patient care. Some clinicians also prefer relying on their own judgment and experience rather than incorporating CDSS recommendations into their practice. Additionally, there is a notable preference among some patients for providers who employ traditional diagnostic methods, viewing them as more trustworthy and competent compared to those who rely on clinical decision support tools. Regrettably, this small subset of individuals may overlook the advantages offered by CDSS, such as mitigating clinician burnout and errors and promoting improved health outcomes for patients.

Yet, as the world of health care continues to evolve, it becomes increasingly important for both providers and patients to embrace practices and technologies that facilitate the most effective and efficient delivery of care. Despite the challenges and initial reluctance, integrating CDSS into clinical workflows holds the promise of optimizing patient outcomes and improving overall health care quality. Therefore, fostering greater acceptance and utilization of these tools is essential for advancing health care practices and ensuring the delivery of high-quality care to all patients, especially in an era where there’s a strong drive to reduce costs, minimize risks to patients, prioritize clinician well-being and exceed the satisfaction of both clinicians and patients.  

Every clinician aims to deliver exceptional care to their patients while also seeking the most efficient methods. As health care leaders navigate the complexities of traditional practices, they pave the way for technological advancements. Organizations offering innovative solutions, such as a CDSS, are at the forefront of redefining care delivery by clinicians. Through these advancements, trust and engagement from patients can be enhanced, marking a significant step forward in improving health care outcomes and experiences for all.

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A gifted few have a memory of an elephant, smoothly juggling large amounts of information, but many of us rely on reminders. Similar to healthcare, it is impossible to remember every aspect of patient care. Medicine is quite complex, and memory alone cannot keep up with changing best practices, standards of care, and medical technology growth while simultaneously taking care of multiple patients.

The relentless pursuit of safety in aviation and the chase for patient safety and quality in healthcare are often studied and compared. One of the widely touted safety successes in aviation is using checklists. In the insightful book The Checklist Manifesto, we discover the transformative power of a simple checklist. Translated to current healthcare, clinical decision support systems (CDSS) have become the dynamic checklist of modern medicine. When embedded in the electronic health record (EHR) workflow, it will ensure standards of care that will standardize diagnostics and treatment plans.

Understanding CDSSs

CDSSs provide recommendations, alerts, or other methods designed to assist clinicians with making decisions with patient care, ideally at the point of care. However, what does that entail during patient care? It depends on the type of CDSS deployed. Primarily, there are two types: knowledge-based and non-knowledge-based CDSS. Knowledge-based CDSS leverages a comprehensive knowledge base comprising medical data and rules to provide informed recommendations and alerts to clinicians. Non-knowledge-based CDSS deploy machine learning (ML) algorithms and artificial intelligence (AI) to analyze vast data volumes, identifying patterns and trends that may not be immediately discernible.

Additionally, CDSSs are characterized as active or passive, meaning a passive system requires the user to do something to receive advice, like opening a dialogue box. In contrast, an active system automatically provides prompts based on information received. CDSS are potent tools that manifest in different forms, such as alerts, clinical diagnostics, drug contraindications, or order sets. We have seen evidence of effectiveness in medication safety with consistent CDSS usage. My organization incorporated drug-to-drug alerts that warn of possible allergy contraindications and suggest alternatives. Although pharmacists also review drug interactions, a CDSS provides an initial check that saves pharmacist a 45% reduction in time spent on verifying. The next step is to incorporate a decision support system that can adhere to clinical practice guidelines (CPGs).

While the adoption of CDSS in healthcare settings is growing, there are still substantial challenges to overcome. As we advance, the focus should be on addressing these barriers to further increase the adoption and optimization of these systems.

Clinical Practice Guidelines

Clinical practice guidelines are a consortium of recommendations to aid with diagnosing and treating a concern or condition. “The principal benefit of guidelines is to improve the quality of care received by promoting interventions of proven benefit and discouraging ineffective or potentially harmful interventions.” Additionally, CPGs can assist with diagnosis variance and treatment plans by establishing standards, including physician biases, which adversely affect patient care. “Bias in clinical practice, in particular in relation to race and gender, is a persistent cause of healthcare disparities.”

With the advancement of technology, the EHR can incorporate continuous CPGs. Unlike traditional provider methods of solely learning new techniques via continuing education credits or conference attendance, CPGs are updated as new facts and acceptances are established in real-time, which allows for the utmost patient care. “Clinical practice guidelines are the most important document for incorporating scientific evidence into healthcare decision-making recommendations.” When the CDSS is active within the workflow, it can reduce the biases for treatment.

Addressing Misconceptions About CDSS

Oftentimes, physicians’ reluctance to use CDSS is because of the notion that their expertise is discounted. However, CDSS is a tool that complements a clinician’s knowledge and experience while mitigating implicit bias. Additionally, it provides clinicians with additional information and resources, assisting them in making better-informed decisions. The ultimate decision will always be with the physician.

There’s a concern that clinicians might become overly reliant on CDSS, leading them to overlook their clinical judgment or become less skilled over time. CDSS is an aid, not a substitute, for thorough clinical assessment and sound clinical judgment. It’s there to support and enhance decision-making, not to take it over. Lastly, CDSS is not infallible. Various interest organizations have their “own perspective, goals, and intended uses.” Therefore, CPGs incorporated in a CDSS must be transparent, undergo a rigorous review process, and remain independent from payers. Additionally, it’s crucial for clinicians to critically evaluate the recommendations provided by CDSS, considering the entire clinical context and their knowledge.

Need for Widespread Adoption

Paying homage to the movie Field of Dreams alludes to the idea that “If you build it, he will come.” This is not the case for CDSS. Adoption by users remains low even though the evidence shows an increase in patient safety and quality. Suggestions or alerts are ignored for “reasons attributed to end-users’ negative attitudes, evasion or skepticism regarding the system.” Other barriers include a lack of integration within the EHR and trust in the system due to data quality issues. Due to common misconceptions, healthcare culture and resistance to change remain a significant barrier. While the adoption of CDSS in healthcare settings is growing, there are still substantial challenges to overcome. As we advance, the focus should be on addressing these barriers to further increase the adoption and optimization of these systems.

In conclusion, CDSSs are not merely technological advancements but are dynamic checklists poised to reform modern healthcare from its very core. Integral to EHR workflows, CDSS ensures that standards of care are met and consistently exceeded, standardizing diagnostics and treatment plans across the board. The result is an enhanced safety profile with tangible evidence in medication error reductions and a streamlined approach to healthcare delivery. I urge healthcare professionals, policymakers, EHR vendors, and experts to advocate for integrating and optimizing CDSS in healthcare. Our collective effort will ensure that these systems are not only adopted but also to ensure high-quality patient care. The future implications are clear: CPGs, intertwined with CDSS and embedded into clinical workflows, are set to become critical tools in directing evidence-based medicine into actionable healthcare decisions.

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