What is the Evidence to Support the Widespread Use of EMR to aid Clinical Decision Support?
Posted Oct 30 2008 3:22pm
This is a very topical and important question given the billions of dollars soon to be spent on EMR and already expended. Although I am a strong supporter of EMR, I am not aware of good evidence supporting the use of EMR and in many cases the evidence is anecdotal. There are many 'good
stories' about how EMR has benefited care and physician and patient satisfaction
that have been published in the media. Observing other industries, we
intuitively know that if you have good tools that map to the pattern of care
delivery and provide value at points along the way, there will be distinct
benefits. As a short-gap measure, are just computers and connectivity sufficient to move the physicians along the pathway to evidence based clinical
decision making? From a practical perspective, when one is struggling to see
one's patient load, if you are forced to live in two worlds (paper and
electronic) simultaneously, you will be more inefficient. It is difficult to
switch beteen the two media and make decisions in real time using a computer
based 'smart system'. It still requires entering a clinical question and reading
the response, processing the information and applying the information to the
clinical state. The real value in the evidence will come once they flow
naturally from integrated clinical decision support. E.g. I live in one
environment for the majority of my work day (electronic), as I enter information
into the computer (EMR), I am prompted (when appropriate) by information and the
simultaneous ability to initiate decisions or actions.
In my
opinion, there is no short cut. Good clinical decision support tools such as
UpToDate are invaluable - it is important to note that these are not integrated,
however the application of evidence and clinical guidelines requires that
decision support allows the provider to remain time neutral or does not add
significant time to the workload in order to provide care. Otherwise the
solutions will be used by a motivated few and for the remainder, they will slip
back to old habits that are quicker.
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As a short-gap measure, are just computers and connectivity sufficient to move the physicians along the pathway to evidence based clinical decision making? From a practical perspective, when one is struggling to see one's patient load, if you are forced to live in two worlds (paper and electronic) simultaneously, you will be more inefficient. It is difficult to switch beteen the two media and make decisions in real time using a computer based 'smart system'. It still requires entering a clinical question and reading the response, processing the information and applying the information to the clinical state. The real value in the evidence will come once they flow naturally from integrated clinical decision support. E.g. I live in one environment for the majority of my work day (electronic), as I enter information into the computer (EMR), I am prompted (when appropriate) by information and the simultaneous ability to initiate decisions or actions.
To add a comment, please click on the 'Comments' link below