Reflections and themes from a roundtable discussion on clinical decision support

I recently had the privilege of participating in a thought-provoking roundtable discussion about Clinical Decision Support (CDS). This event brought together a diverse group of professionals across health and academia as well as patient representatives. Our discussions touched upon a range of important themes and considerations within the realm of CDS, shedding light on the current state of this critical field and its future direction.

1. Empowering Clinicians with Reliable Information

One prominent theme that emerged from our discussions was the vital role played by platforms like Uptodate BMJ Clinical Practice and VAR. These platforms provide clinicians with access to reliable information and evidence, helping them make informed decisions in their daily practice. Furthermore, some facilitate the dissemination of patient-friendly information materials, supporting better communication and self management.

2. National Guidance on CDS

We recognised the significance of recent NHSE guidance on Clinical Decision Support. This guidance underscores the growing importance of CDS in the healthcare landscape. However, an important question that surfaced was how we can ensure that this national guidance creates a compelling case for the adoption of CDS enabled by technology across various healthcare provider organisations.

3. Turning Information into Action

CDS was celebrated for its potential to transform raw information into actionable insights. This spans the spectrum, from evidence-based guidelines to data-driven algorithms, with the goal of making these resources easily accessible to clinicians through Electronic Patient Record systems (EPRs).

4. Challenges and Complexities

Our discussions highlighted several key challenges and complexities for CDS adoption in EPR’s:

• Population Health and Person-Centred Care: Integrated Care Systems (ICS) must align their objectives with the WHO Sustainable Development Goals. CDS systems should incorporate evidence across a wide range of factors, addressing not just acute medical care but also activities of daily living and broader determinants of health.
• Education: Bridging the gap between theory and practice is crucial. Many educators still have an analogue mindset, underscoring the need for comprehensive digital transformation in healthcare education.
• New Roles: To realise the vision of ICS and population health management, we must develop new roles and grow a workforce skilled in digital, data, analytics, and technology. This requires a collaborative effort between education providers and healthcare services.
• Algorithms and Inequalities: Algorithms built solely on available evidence can perpetuate healthcare inequalities. More research is needed to address social determinants of health and build systems that use AI to direct interventions that address these.
• Overload and Alert Fatigue: Information overload can lead to alert fatigue among clinicians, potentially compromising patient safety rather than delivering the intended safety benefits.
• Complexity of Guidelines: The abundance of guidelines at local, national, and international levels can be overwhelming.? The burden on clinicians developing local guidelines when off the shelf well governed guidance already exists is duplicative, unnecessary and can lead to unwarranted variation.
• Integration: CDS should evolve to deliver guidance tailored to the right clinician at the right time, integrating seamlessly into their workflows.

5. Integration Engine in Knowledge Management

One critical question that emerged was the role of the "integration engine" in knowledge management or more simply who we serve the information to and how do we do it to ensure information is turned into action. Should it be the empowered patient, the clinician, or technology? ?Each of these ‘stakeholders’ faces unique challenges in fulfilling this role, with trust and power dynamics at the heart of the issue.

6. Consultant's Testimonial

A particularly compelling moment during our discussions was when a consultant shared their daily use of tools to support their clinical decision making. They emphasised that in the ever-evolving landscape of healthcare, it is impossible to know everything and keep up with all new evidence. Better decisions are made when clinicians draw upon collective knowledge, which extends beyond personal experience to encompass worldwide literature. This reflects a significant shift in healthcare, from an era of all-powerful experts to knowledge managers.

In summary, our roundtable discussions revealed the intricate tapestry of challenges and opportunities in the realm of Clinical Decision Support. We emphasised the importance of education, the need for streamlined guidelines, and the collaborative efforts required among patients, clinicians, technology, and wider healthcare systems to deliver on the promise of healthier populations through Integrated Care Systems (ICS). The journey ahead is complex, but it is one that promises to reshape healthcare for the better, with knowledge and collaboration at its core.

?