“There exists far too much medical information for the human brain to keep it all in mind, and apply it in a consistent and thorough fashion during a medical encounter.” Leslie Kernisan, M.D., in the blog post, Medicine in Denial.
“Any system of care that depends on the personal knowledge and analytic capabilities of physicians cannot be trusted,” Dr. Lawrence Weed and Lincoln Weed, in their book Medicine in Denial.
Is “practicing medicine” in the model we’ve traditionally known, impossible today? Is there so much scientific knowledge to know, that it’s unknowable? Do we want – as a consumer, a manager of a health care organization, and payer – to turn our clinical professionals into Watson? (Watson is an artificially intelligent, question answering computer system built by IBM, see Finding Your “Watson” all members, WellPoint Using IBM Watson To Improve Physician Decision Support , and Innovate or Else? all members)
Or is it just that we want our clinical professionals to have a “mind meld” with Watson? (For those of you who are not Star Trek fans, a “mind-meld” is a technique used by the Vulcans for sharing thoughts and knowledge with another individual – a form of telepathy, see Star Trek Mind-Meld, Vulcan for a more robust description of the possibilities.)
What we do know is that clinical decisionmaking is highly variable – the Institute of Medicine (IoM) put out a report last fall that noted, “Available knowledge is too rarely applied to improve the care experience, and information generated by the care experience is too rarely gathered to improve the knowledge available” (see The Growing Bandwagon For Standardizing Service Delivery all members).
The obvious solution to this is clinical decision support (CDS) tools. These are “active knowledge systems which use two or more items of patient data to generate case-specific advice” (see Decision Support Systems), with the objective of processing large amounts of data automatically to provide clinicians with a greater awareness of the population than available simply through an individual clinician’s experience.
CDS are not common (see No Decision Support Tools? You’re Not Alone all members), but that is changing. According to a recent survey conducted by Black Book Rankings (see ACOs and Pharma Drive Clinical Analytics Sector to be Health IT’s “Next Big Thing”) that “surveyed 1340 IT and clinical leaders from hospitals, ACOs, managed care, pharmaceutical manufacturers and physician practices,” CDS adoption is a high priority for health care providers:
89% implemented CDS to prevent medication errors.
77% achieved anticipated cost savings from analytics-driven patient care.
69% noted improvements in studied population health.
84% of those provider organizations without CDS systems…plan to acquire at least one…within twelve months.
I expect we’ll see more use of CDS in the future for many reasons. First and foremost, consumers are starting to question the recommendations of their clinical professionals – by using on-line and smartphone decision support tools, and finding their own information. Sixty percent of consumers using mHealth services say they’ve already replaced some visits to health care professionals using mobile interventions (see For Apps, Consumers Are In all members).
Secondly, there is the liability issue. If a clinical professional in our system makes a decision that flies in the face of “science” there can both bad clinical outcomes, as well as huge financial liabilities for the provider.
And thirdly, there is cost. Can we really afford to continue to pay for clinical interventions that clearly are not optimal (I’m excluding here the situations where there is a difference in approach). For example, unnecessary surgeries might account for 10% to 20% of all operations (see Doctors perform thousands of unnecessary surgeries).
In the past, most provider organization managers have rarely cared if payers paid for interventions that didn’t work, because it didn’t have a financial impact. But as we move to value-based reimbursement, the financial incentives are tipped in a different direction.
Maybe we do want that Watson mind-meld.
For another free resource, see: The Era of The Tech-Enabled Caregiver all members