{"id":43005,"date":"2018-09-11T12:10:22","date_gmt":"2018-09-11T11:10:22","guid":{"rendered":"https:\/\/blogs.bmj.com\/bmj\/?p=43005"},"modified":"2018-09-11T12:10:22","modified_gmt":"2018-09-11T11:10:22","slug":"kieran-walsh-clinical-decision-support-only-works-when-used","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bmj\/2018\/09\/11\/kieran-walsh-clinical-decision-support-only-works-when-used\/","title":{"rendered":"Kieran Walsh: Clinical decision support\u2014only works when used"},"content":{"rendered":"<p><span style=\"font-weight: 400\">Clinical decision support can improve health outcomes and reduce the risk of medical error. But it isn\u2019t always used. And a bit like a wondrously effective drug\u2014when it\u2019s not used, it doesn\u2019t work. So why isn\u2019t it used?<\/span><\/p>\n<p><span style=\"font-weight: 400\">Khairat and colleagues have recently published an intelligent paper that attempts to explain why. [1] They reviewed studies that evaluated user acceptance of clinical decision support. They found lots of reasons why clinical decision support isn\u2019t used. Sometimes it was because it interfered with the clinician\u2019s workflow and sometimes because it took too much time (which meant less time with patients). Some clinicians thought that they were receiving too many alerts from clinical decision support systems; others that they didn\u2019t feel they could rely on the evidence underlying the content. Some clinicians found clinical decision support both difficult to use and not useful. \u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\">This is a helpful summary but there isn\u2019t a great deal new in it. Clinicians have been complaining about these shortcomings of clinical decision support for many years. And providers have been trying to improve clinical decision support in light of them for many years. For example, they have tried to have fewer alerts or to make the content shorter or to make it more evidence based.<\/span><\/p>\n<p><span style=\"font-weight: 400\">But these strategies haven\u2019t always worked either. Fewer alerts mean that important alerts are sometimes missed out. Shorter content means that not all clinicians will feel that they are getting content in sufficient detail. It is difficult to get it right for all healthcare professionals in all circumstances. \u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\">But this paper suggests another strategy to deal with the problems that we have with clinical decision support. It states that a more fundamental problem is that doctors don\u2019t know why they are getting alerts or whether the clinical content they are seeing is evidence based or what point on an algorithm they might be on\u2014that, in other words, clinical decision support \u201c<\/span><span style=\"font-weight: 400\">is a black box to the physician.\u201d The authors think that the fact that clinical decision support tools \u201cdo not reveal how output decisions are made may be a driving force behind the lack of users\u2019 acceptance.\u201d And they suggest that creators of clinical decision support should start being more transparent.<\/span><\/p>\n<p><span style=\"font-weight: 400\">Our experience with BMJ Best Practice is that users certainly do appreciate being able to delve into the underlying evidence base if they want to\u2014even though we realise that they don\u2019t always have time. This also helps them to get an answer quickly\u2014if they are at the point of care. And also to spend more time and to read around the subject\u2014if they are at the point of going to the library.<\/span><\/p>\n<p><span style=\"font-weight: 400\">The authors acknowledge that their ideas need to be validated. Similarly, we have not subjected all our experiences to independent trials. But evidence from other walks of life\u2014from healthcare to information technology to retail\u2014suggests that listening to users and explaining to them what you are doing is a good idea.<\/span><\/p>\n<p><em><strong>Kieran Walsh<\/strong>\u00a0is clinical director of BMJ Learning and BMJ Best Practice. He is responsible for the editorial quality of both products. He has worked in the past as a hospital doctor\u2014specialising in care of the elderly medicine and neurology.\u00a0<\/em><\/p>\n<p><em><strong>Competing interests<\/strong>:\u00a0Kieran Walsh works for BMJ Learning and BMJ Best Practice which produce a range of resources on infectious and non-infectious diseases.<\/em><\/p>\n<p><b>References:<\/b><\/p>\n<ol>\n<li><a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/?term=Khairat%20S%5BAuthor%5D&amp;cauthor=true&amp;cauthor_uid=29669706\"><span style=\"font-weight: 400\">Khairat S<\/span><\/a><span style=\"font-weight: 400\">,\u00a0<\/span><a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/?term=Marc%20D%5BAuthor%5D&amp;cauthor=true&amp;cauthor_uid=29669706\"><span style=\"font-weight: 400\">Marc D<\/span><\/a><span style=\"font-weight: 400\">,\u00a0<\/span><a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/?term=Crosby%20W%5BAuthor%5D&amp;cauthor=true&amp;cauthor_uid=29669706\"><span style=\"font-weight: 400\">Crosby W<\/span><\/a><span style=\"font-weight: 400\">,\u00a0<\/span><a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/?term=Al%20Sanousi%20A%5BAuthor%5D&amp;cauthor=true&amp;cauthor_uid=29669706\"><span style=\"font-weight: 400\">Al Sanousi A<\/span><\/a><span style=\"font-weight: 400\">. Reasons For Physicians Not Adopting Clinical Decision Support Systems: Critical Analysis. <\/span><a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/29669706\"><span style=\"font-weight: 400\">JMIR Med Inform.<\/span><\/a><span style=\"font-weight: 400\">2018 Apr 18;6(2):e24.<\/span><\/li>\n<\/ol>\n","protected":false},"excerpt":{"rendered":"<p>Clinical decision support can improve health outcomes and reduce the risk of medical error. But it isn\u2019t always used. And a bit like a wondrously effective drug\u2014when it\u2019s not used, [&#8230;]<\/p>\n<p><a class=\"btn btn-secondary understrap-read-more-link\" href=\"https:\/\/blogs.bmj.com\/bmj\/2018\/09\/11\/kieran-walsh-clinical-decision-support-only-works-when-used\/\">More&#8230;<\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[5732],"tags":[],"class_list":["post-43005","post","type-post","status-publish","format-standard","hentry","category-kieran-walsh"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.5 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Kieran Walsh: Clinical decision support\u2014only works when used - The BMJ<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/blogs.bmj.com\/bmj\/2018\/09\/11\/kieran-walsh-clinical-decision-support-only-works-when-used\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Kieran Walsh: Clinical decision support\u2014only works when used - The BMJ\" \/>\n<meta property=\"og:description\" content=\"Clinical decision support can improve health outcomes and reduce the risk of medical error. 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