The idea of meaningful use, mandated by the American Recovery and Reinvestment Act, has been whittled down into defining the enigmatic term “meaningful.” In this search, discussions within the Office of the National Coordinator for Health IT and the Association of Medical Directors of Information Systems (AMDIS) have focused on the practice of medicine, not the implementation of IT. If the meaningful use of information systems does not have an obvious and profound impact on the safety and quality of healthcare, then it ceases to have meaning.
Clinical decision support systems (CDS) are poorly understood. Simplistically, a CDS electronically unites elements of patient-specific information (such as age, weight, comorbidities) to provide clinicians with insight into the appropriate patient care. For instance, if you have a patient’s diagnosis, along with his or her ethnic background, you can make other associative recommendations. CDS allows for the business of medical care by providing a review of the patient, along with treatment plans.
One problem with U.S. healthcare is that we’ve been spending a tremendous amount of money on results that are not aligned with the investment. This summer, the World Health Organization ranked the U.S. 37th out of 191 countries. Yet, 2008 healthcare expenditures equaled $2.4 trillion, and is estimated to reach $4.3 trillion by 2017. The country can no longer afford to invest without proper patient results.
Conversely, CDS is a prime example of using IT to improve patient outcomes, providing a better measure to evaluate the effectiveness of treatments. CDS provides everything from the promulgation of guidelines, alerts about complex interactions between medications, possible patient reactions to treatments, as well as access to other data.
Too much remains unknown within the practice of modern medicine in terms of treatment plans, medications and procedures. However, we are involved in the practice of medicine—always evaluating, learning, and hopefully, evolving. In the past, physicians had to rely solely on their memories and the advice of peers. In the information age, we can use data tools to assist with accumulating collective experiences and aggregating large data sets. With CDS, we are able to bring together thousands of case histories on a particular diagnosis.
If applied well, these data can be useful in every healthcare setting. For example, George Reynolds, MD, CMIO at the 145-bed Children’s Hospital of Omaha, Neb., brings his colleagues together weekly to share different challenges displayed on a dashboard. He has transformed medical care at his small pediatric hospital so the group makes all their decisions based on the data, from testing decisions to technology adoption to better guideline adherence.
Traditionally, this type of data aggregation and dissemination could only be reachable in healthcare with the gold-standard method of prospective, randomized, controlled trials. However, the trials require a great deal of time and funding. For instance, the National Cancer Institute’s National Lung Screening Trial has been ongoing for the last decade, and the results have yet to be reported.
It is time to start leveraging our silicon brains and move medicine into a new age, using computerized analysis and reporting that have revolutionized other industries. In this country, unfortunately, healthcare will be one of the last industries to adopt these models. It’s not the fancy user interface nor exciting iPhone applications for telemetry care, but rather, data alone which will bring about meaningful use.
During this time of U.S. healthcare reform debate, CDS will reveal its importance as a means to prove results. However, most importantly, these data, provided by CDS, will improve patient care by providing physicians with the most up-to-date information to treat individual patients—which is the real practice of medicine.