We (patients and clinicians) need all the help we can get making informed health care decisions. We need the right information to the right person, in the right format, through the right channel, at the right time in our life flow and workflow – The five rights. Let’s take managing acute pain as an example. Clearly, we need to make some decisions together. I (the patient) am in pain for whatever reason – hurt my back, migraines, colitis, sickle cell, a million reasons. I (the clinician) need to help my patient manage that pain with the least long-term risk possible, e.g. relief with maximum function without addiction, constipation, confusion, whatever. This pain could be new – never had it before, or familiar – chronic (we have experience with what works and what doesn’t). Clinical decision support can help us to structure and inform a routine to make choices based on research and clinical and life experience. What has worked for groups of people (those with acute back pain, migraines, colitis, sickle cell) and what has worked for the individual (me or my patient)? We can welcome this decision support when symptoms first occur, when the patient and clinician first communicate, when they first meet about the symptoms, or as we try treatments until the pain goes away or is manageable – anytime from first pain to living with pain to no pain.
Decision support could include recording historical and current functional status, pain levels, and treatment goals shared with the patient and/or caregiver previsit to be completed at home via the patient portal or paper or in the office via tablet, kiosk, or paper. During the clinical visit, the patient/caregiver could be introduced to a log, journal, app, or portal to collect ongoing pain level, medical and non-medical treatment, functional status, etc. During the visit the patient/caregiver could be instructed in potential risks, mitigating strategies, and guidelines for direct communication with the clinic after the visit or between visits via phone or portal. The clinic website could house community resources that may support the patient and caregiver in online communities and non-medical determinants of health as well as answers to frequently asked questions.
Sounds simple, but it isn’t. Our workflows and life flows aren’t set up for it. Challenges to further developing clinical decision support include educating clinicians and patients to think systematically and use CDS tools, engaging each other upstream from visits, developing more collaborative trusting relationships, building electronic tools for tracking and communication, authorizing personal information sharing across settings and time, and designing clinic workflow and reimbursement so patients and their clinicians have sufficient time together to make informed decisions.
I’m particularly interested in how we educate ourselves and each other as patients, caregivers, and clinicians to make the best use of clinical decision support for informed decision-making discussions. Think of putting together Ikea furniture – some of us read the directions, some of us plow on ahead. Different experience, different training needs. Think of learning to use an app. Some of us try every new thing and use it for five minutes and move on. Some don’t try. Some call their grandchildren for help. Different experience, different training need. Think of traveling in a foreign country by car. Some people use a map, some use GPS, some ask for directions, some don’t. Different experience, different training needs. Think of deciding what treatment to try? Some call it making choices. Some call it informed decision making, Some call it shared decision-making. Some don’t think about deciding at all. It’s not so simple, is it?
Check out the Patient Expertise Blog on the Patient-Centered Clinical Decision Support – Learning Network.