‘Modest’ feedback
A couple of months ago, I posted, “A modest proposal,” my observations about a session on clinical decision support from the American Medical Informatics Association annual meeting. In it, I argued that medical informatics needed a rock star of sorts to help humanize the issue of clinical decision support and communicate the benefits of such technology to the general public.
I got three comments on that post—actually pretty high for this blog—as well as several e-mails. One correspondent said we need more than a rock star, we need the whole band. I passed that comment on to Dr. Bill Bria, CMIO of Shriners Hospitals for Children, who was part of the panel at the AMIA meeting, who told me that he once led an all-physician rock band called the Straight Caths. It still may take the Rolling Stones or perhaps an entire Woodstock to make some of the changes American healthcare needs. Then again, Thursday is Elvis’ birthday.
One non-physician wrote: “That was terrific. Thanks! Except, while I don’t disagree, maybe if they learned to speak English, too, it would help.” Actually, Joan Ash of the Department of Medical Informatics and Clinical Epidemiology at Oregon Health and Science University made a similar point in said AMIA session.
CareGroup Healthcare System CIO Dr. John Halamka, himself a rock star in health IT circles for his incredible ability to juggle so many responsibilities (and perhaps for his Johnny Cash wardrobe), pointed me to one of his blog posts about his idea for ASP-style “decision support service providers”
One vendor executive wrote: “Its a shame that these guys seem to believe that CDS just means medication decision support when there are many other steps that use and benefit from DS.” This writer said there should be more of a focus on diagnosis decision support. The e-mail also included a quote from Dr. Donald Berwick: “Genius diagnosticians make great stories, but they don’t make great health care. The idea is to make accuracy reliable, not heroic”
Just think, a well-implemented clinical decision support system could finally give Cuddy a reason to fire House. I think about that every time I watch that show. It’s sad that trial and error can produce such great television.
Hi Neil,Thanks for your earlier “proposal” and this posting of the commentary. Your blog is an excellent resource and I enjoy reading it immensely. Patient/Disease registries with point-of-care decision support have repeatedly shown improved care and clinical efficiency at a fraction of the cost of most EMRs. BMJ’s 2005 meta-analysis of decision support systems reported registries as the most effective means of impacting care. A 2004 CHCF report showed registries to be a cost-effective way of improving care quickly and at a reasonable cost. A 2007 paper published by the Center for Information Technology Leadership reaffirmed this concept.Presbyterian Healthcare Services of New Mexico deployed a registry/decision support tool over 90 days in support of their ambulatory physicians treating Diabetics. Within 120 days, they reduced the number of diabetics with poor A1c control from 26% to 12%. They have worked that number down to around 10% and hospitalizations (Medicare patients) for those patients being managed with the registry/DS are 26% less frequent than those not being managed with the registry/DS.Mike Nelson, MD (Director Patient Quality/Safety) could be a “rock star” as he’s the brains who made it all happen.Anyways, all this talk about EMRs/digitizing offices is a red herring. We need to be focused on providing physicians simple, effective and affordable IT tools that ACUTALLY demonstrate improved care.At least, that is my opinion… :)Thanks again Neil!
Great article as always, Neil. I think there are 2 subtle dimensions in this story. First, we need to overcome the perception that medicine is too complex for computers beyond administrative automation and relatively simple rules. Second, as part of that shift, we need to see an increased focus on CDS as a diagnostic as well as a treatment aid. I’ve expanded on this idea and your post on my blog this morning.Thanks again, I always enjoy reading your posts.Jasonhttp://blogs.sas.com/hls
Awesome, and too true.By the way, CMIO here – Dirk Stanley, MD, MPH, from Cooley Dickinson Hospital, Northampton, MA -If you’re on Facebook, look me up – We’re starting a CMIO discussion group and hopefully, we’ll come up with the rock star / rock band we need. :)- Dirk ;)