Computerized clinical decision support can be essential buttress for the new normal of team-based primary care
Team-based primary care is increasingly viewed as an answer to the persistent problem of finite healthcare resources strained by current and future pandemics, an aging U.S. population and escalating healthcare costs. A paper from informaticians Paul Dexter, M.D. and Titus Schleyer, DMD, PhD, of the Regenstrief Institute and Indiana University School of Medicine, champions well-designed computerized clinical decision support embedded in electronic health record systems as a necessary and effective tool to ensure that team healthcare functions optimally, ensuring safe and efficient care delivery.
“A clinical team supplemented by a well-designed computerized decision support system are more powerful than one or the other and becomes more effective and safer,” said paper co-author Dr. Dexter. “The challenge is to be creative in figuring out how software can facilitate team approaches to healthcare by coordinating group effort and enhancing communication among team members.
“It’s no longer just a single physician taking care of a patient; today, we need to weave in multiple additional providers to the medical care paradigm, including nurse practitioners, physician assistants, nurses, social workers, health educators, therapists and pharmacists, all who add complementary expertise. We must also ensure the availability and usability of computerized clinical decision support that fit the needs of a variety of primary care practices,” said Dr. Dexter. “EHR vendors have a long way to go to optimally support team-based care, but I am confident it will be figured out given the underlying need.”
Computerized clinical decision support provides evidence-based information and guidance. In addition to providing medical references, such as a reminder that a patient is eligible for a specific vaccine, these tools can alert when a patient hasn’t followed through on a recommended cancer screening or specialist referral; send a notification when a new drug relevant to the patient’s condition receives FDA approval; or convey a standing order for a team member to contact a patient on a specific schedule. Alerts and messages are securely presented to specific team members for reference and potential response when appropriate.
In their paper, Drs. Dexter and Schleyer identify opportunities for computerized clinical decision support to enable primary care physicians to spend more of their time overseeing a diverse healthcare team, rather than personally delivering the majority of care, thereby increasing efficiency without sacrificing quality. They see benefits in the following areas:
- preventive care
- acute conditions commonly treated at retail clinics such as sore throat or sinusitis
- diagnostic workup of new onset symptoms
- chronic care
- medication reconciliation
- renewal of non-narcotic medications
- tracking of referrals including recommendations from the specialist
- follow-up on missed appointments or diagnostic testing
“We are only at the very beginning of enabling truly effective and efficient team-based primary care using computerized clinical decision support. Key to doing so successfully is to thoroughly understand how clinicians and patients work together and interact in the context of clinical care. Only with that understanding can we design the right support using information technology and informatics,” added Dr. Schleyer.
“Golden Opportunities for Clinical Decision Support in an Era of Team-based Healthcare” has been published in the AMIA (American Medical Informatics Association) Annual Symposium Proceedings. Drs. Dexter’s and Schleyer’s work was supported by funding from the National Institutes of Health’s National Human Genome Research Institute grant #U01 HG010245, the Indiana Clinical and Translational Sciences Institute (funded in part by award number UL1TR002529 from the National Institutes of Health’s National Center for Advancing Translational Sciences) Clinical and Translational Sciences Award, and the Lilly Endowment, Inc. Physician Scientist Initiative.
About Paul R. Dexter, M.D.
In addition to his role as a research scientist at Regenstrief, Paul R. Dexter, M.D., is an associate professor of clinical medicine at Indiana University School of Medicine.
About Titus Schleyer, DMD, PhD
In addition to his role as a Regenstrief Institute research scientist, Titus K. Schleyer, DMD, PhD, is the program director for learning health informatics at Regenstrief and is a professor of biomedical informatics at Indiana University School of Medicine.
About Regenstrief Institute
Founded in 1969 in Indianapolis, Regenstrief Institute is a local, national and global leader dedicated to a world where better information empowers people to end disease and realize true health. A key research partner to Indiana University, Regenstrief and its research scientists are responsible for a growing number of major healthcare innovations and studies. Examples range from the development of global health information technology standards that enable the use and interoperability of electronic health records to improving patient-physician communications, to creating models of care that inform practice and improve the lives of patients around the globe.
Sam Regenstrief, a nationally successful entrepreneur from Connersville, Indiana, founded the institute with the goal of making healthcare more efficient and accessible for everyone. His vision continues to guide the institute’s research mission.
About IU School of Medicine
IU School of Medicine is the largest medical school in the U.S. and is annually ranked among the top medical schools in the nation by U.S. News & World Report. The school offers high-quality medical education, access to leading medical research and rich campus life in nine Indiana cities, including rural and urban locations consistently recognized for livability.