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TECHNOLOGY


The case for clinical decision support


Even the most experienced consultant will come across new cases and symptoms that they have not seen before. Dr. Stephen Jackson argues that clinical decision support technology could provide vital information to help reduce errors and boost efficiency across the NHS.


As CMO at University Hospitals of Leicester NHS Trust (UHL), I am evangelical about the technology we have available to our clinical staff, including Clinical Decision Support (CDS), which is growing in use at NHS hospitals around the country. The evidence I see daily is that this extra support for clinicians benefits Trusts by improving safety, making our work more efficient, delivering better value, and boosting patient safety. The best CDS tools can deliver evidence- based insights into thousands of health topics, including new research, latest guidelines, and position statements. I am an advocate for using CDS resources at the point-of-care, via a smartphone or tablet, to provide accurate information to the clinician, exactly when and where it’s needed. Easy access to authoritative clinical information can boost consistent decision-making, standardised care and improved outcomes, especially when the CDS tool is integrated into the Electronic Health Record (EHR), which is increasingly common.


These are the text-book reasons for using CDS, but from personal experience, I find the case to embrace this growing technology is more nuanced, reflecting changing work patterns and responsibilities in the NHS. For example, as a senior doctor, I think it’s always important to recognise the gaps in my knowledge. I routinely consult UpToDate (Wolters Kluwer), which is the CDS tool we use at UHL. I find it’s invaluable when I come across a condition I don’t know much about or remember reading about years ago. There’s no embarrassment in that. There is so much new evidence and research coming out every day that doctors cannot possibly possess this knowledge across everything, all the time. The more experienced you get, the more you become comfortable with that. You realise there are inevitably going to be things you don’t know, and the wisest course of action – in the best interests of the patient – is to seek support, whether that’s from a CDS tool like UpToDate or the advice of specialist colleagues.


Some critics have voiced concern that the rise of CDS is leading to a ‘medicine by numbers’ approach, where years of training and experience are replaced by consulting an app; absolutely not. I strongly believe that technology like this has its place supporting, not replacing, the expertise of a clinician. Although the tools available to help us make decisions are getting better and more widespread, most of my experience is still learned from speaking with specialist colleagues. That said, we have to acknowledge that even the most experienced consultant will come across new cases and symptoms they’ve not seen before and could benefit from the recommendation, or evidence, this technology provides. Human intelligence and experience will always play the primary role, but supporting technology can provide an added layer of certainty that saves time, money and boosts safety.


Know when you don’t know In many ways, I find myself using UpToDate more now than I would have done as a junior doctor. Back then, I may have felt under pressure to have the knowledge at my fingertips, but now I’m confident in myself to ‘know when I don’t know’ and seek decision support.


The rising use of CDS in the NHS reflects how times have changed. Nowadays, we realise that the buck stops with us senior doctors. You often find a patient care- plan includes ‘for senior review’ which, in practice, usually means the junior doctors need senior staff to make the significant decisions. That’s quite different to when I was a junior doctor – we recognised we were responsible for making decisions, but nowadays, the expectation is on the consultant.


CDS can also protect us in the event of legal challenges surrounding patient care. If a medical case is ever the subject of a


60 l WWW.CLINICALSERVICESJOURNAL.COM FEBRUARY 2021


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