SSince Hippocrates first brandished a pair of bronze forceps, physicians have aimed for quality care. Now, the move toward value-based reimbursement means quality improvement is an imperative. Proper use of CDS is essential to getting there.
This is an interesting review of clinical decision support and timeline for implementing clinical decision support methodologies. In my experience the best medical decisions and treatment plans are developed when all medical providers have access to all clinically relevant medical records and when complex medical diagnoses and treatment plans are developed and followed by the patient’s medical team. Patient’s do not generally select their doctors by EMR system so their medical records usually reside within multiple EMR systems that so not currently communicate. Each medical provider documents his or her experience in their EMR system and render opinion and treatment plan based upon the limited information available to that provider and without the benefit of a holistic overview of all the patient’s records that might be available from a Federated medical record. Any Clinical Decision Support method based upon this limited data will also be more limited in scope and context than on based upon Meaningful Collaboration.
Health Information Exchanges are challenged because the data contributed is generally over represented by hospital data and under represented from individual outpatient practices where most episodic care is provided. In addition the data contributed may be in inconsistently structured format that is difficult for providers to search or consume in an efficient manner. The Big Data problem makes it difficult for providers to distill exactly what they need to know from the majority of data that is not clinically useful
In the old days, doctors rounded on hospital patients and contributed to progress notes as part of a medical team. A doctor would review the notes of other doctors, nurses, social workers, and other specialists. Each provider would contribute external content that the provider though t would be helpful to the team and would point out the pertinent lab results or tests that were deemed pertinent. This analogue version of Meaningful Collaboration allowed medical providers to visit at various times of the day and collaborate asynchronously to the patient’s care. When there was need for synchronous group collaboration, a conference would be scheduled such as “Tumor Board” or “Grand Rounds”. There is a need for this type of collaboration between medical providers residing in different EMR systems. Meaningful Collaboration advocates for innovative healthcare collaboration platforms and methods that support synergistic models for healthcare collaboration.