Clinical Decision Support not Just for Clinicians?

Optimized-AsthmaInhalerContinuing on the topic of clinical decision support, (CEO of Health 2.0 Indu Subaiya hosted a related conversation on Wednesday) a session at iHT2’s Health IT Summit this week in San Francisco brought up an unusual question. Maybe it’s because of the term assigned to them, but clinical decision support tools aren’t typically discussed with respect to patients. But is there a place for them outside of the hospital?

Chief Medical Information Officer of Lucile Packard Children’s Hospital at Stanford, Christopher Longhurst, MD, said yes. He pointed to a recent meta-analysis published in BMJ that examined more than 160 trials. The purpose of the study was to compare different computerized clinical support systems and their effectiveness in terms of outcomes.

“One of the things that they published that’s never been cited before is that the systems most likely to succeed provided advice for the patients in addition to practitioners,” Longhurst said.

An example of patient clinical decision support was the delivery of reminders via Internet, mail, or phone, said the paper. While that sounds a lot like what many organizations are already doing or at least considering, patient advice falls in a different category when it’s advice to patients who are responsible for part of their own clinical care — for example, if they have to decide when to administer their own injections.

Longhurst said his hospital applied the idea of patient clinical decision support to a home management plan of care (HMPC) for asthma patients about to be discharged from the hospital. “This is something the Joint Commission regularly audits for pediatric patients. Our compliance was poor a couple of years ago,” Longhurst said, citing that 65% of patients adhered to the plan.

The Stanford University School of Medicine Department of Pediatrics published a paper describing how the hospital integrated the plan into its electronic record. The system checked that the plan of care was completed before the entry of an inpatient discharge order. Longhurst said that today compliance with the HMPC is at 95%.

“It was the decision support that we were giving, not just to the providers, but to the patients that we’re serving that helped really change outcomes related to children with asthma,” he said.

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