The practice of medicine has evolved. More than ever, it’s incumbent on healthcare providers to access and understand the latest in evidence-based research in order to make decisions that have real impact. Leaders are turning to technology like telemedicine to enable evolution of information access and guidance.
To achieve this, leaders are implementing a variety of tech initiatives to improve the way they deliver care. We explore these further.
1. Full access to the right data and information
Many of healthcare’s change initiatives going back two decades can be traced to the optimization and coordination of health data. Yet until now, so much essential data has remained siloed, unstructured, inconsistent, or proprietary. Furthermore, clinicians today are faced with a dizzying volume of research, emerging information, government and health organization guidance, and the need for speed.
During the first years of the Covid-19 pandemic, private and public stakeholders around the world got together, tearing down the walls that keep data apart. Healthcare data functions as the brain and central nervous system for decision-making. Unfortunately, beyond a pandemic, sharing health data for research across borders has remained very difficult.
In order to improve care coordination and get closer to a truly patient-centered care model, the barriers to accurate and actionable data must be removed.
Clinicians often need treatment recommendations they can trust that don’t yet exist or are not clearly outlined in peer reviewed literature. A systematic review of 48 studies on clinician expectations on the benefits and/ or harms of treatments, tests, or screening tests showed that in most studies most physicians had inaccurate expectations.
Clinicians and patients alike are also confronted with an unrelenting amount of misinformation that is now so pervasive that the World Health Organization has coined it an infodemic. Most guidelines (which clinicians rely on to guide treatment decisions) do not fully acknowledge the poor quality of the data on which they are based. [1]
According to “How to survive the medical misinformation mess” published in the European Journal of Clinical Investigation of 2017 [2] there are four key problems:
- Much of the published medical research is not reliable or is of uncertain reliability, offers no benefit to patients, or is not useful to decision makers.
- Even if they are aware of this problem, most healthcare professionals lack the skills necessary to evaluate the reliability and usefulness of medical evidence.
- Most healthcare professionals are not aware of this problem.
- Patients and families frequently lack relevant, accurate medical evidence and skilled guidance at the time of medical decision-making.
Health misinformation can also undermine the patient-clinician relationship and negatively impact health outcomes. For example, misinformation about medication has been shown to reduce adherence. Patients might be concerned about taking too many medications, and have misinformation or misunderstandings about treatment, thinking for example: “When my test results are normal, I can stop treatment”.
2. Transparency and trust to turn the best evidence into action
Clinicians make decisions for care and management every day, so they must have timely access to guidance that synthesizes the best available evidence augmented by the wisdom of clinical experts and other relevant information sources that should have a bearing on clinical decision-making.
A best-evidence-of-the-moment approach can reliably distill the massive amounts of data that new research and clinical care generate at speed and can transform it into reliable and actionable treatment recommendations. In the past, the slower pace of medical change tended to obscure when care team members were not fully aligned. However, today, when people act on disparate information, care is not just inefficient, it can be truly harmful. In contrast, a rapidly vetted single source of truth creates a true opportunity to align care across settings and, globally, has a dramatic effect on safety, quality, and patient outcomes.
Making the best evidence available in a format that can be used by frontline healthcare providers holds enormous potential for improving post-pandemic care and saving lives – but only if done right. Clinical decision support in the workflow is critically important for aligning and connecting care teams across specialties and settings for helping to standardize best practices and ensuring that patients are offered the best choices based upon the available evidence and clinical experience.
What are the critical components to balancing the best science with action?
- Synthesized evidence
Rigorous processes are required to systematically review relevant sources of evidence.
These must be synthesized thoughtfully and presented to clinicians in a way that they
can be understood quickly and accurately. - Recognizable expertise
Clinical experts are essential to translate published evidence (often incomplete and/
or variable) into recommendations for care. Experts must understand the evidence and
have experience caring for patients with the conditions for which they offer guidance. - Rigor and speed
The process must be efficient but cannot sacrifice quality. This means that content
has to be founded on the best evidence and peer reviewed by specialists following a rigorous process that is clearly outlined. - Easy-to-find information
Clinical decision support should come in formats that easily integrate into work-flows and wherever clinicians are working. Health system leadership’s adoption of this approach into the workflow e.g. via an EMR can expedite appropriate practice change, ensuring clinical improvements enhance the process of building trust. - Peer review
A team effort is required to ensure that recommendations for care are clear, useful
and reflective of contemporary thinking. Formal peer-review processes are essential.
Feedback from clinician end users should be incorporated into the editorial process. - Transparency
Because no clinician can distill the high volume of new data on a regular basis, they
need to understand how experts evaluate data and arrive at a recommendation.
Grading clinical recommendations by the quality of evidence indicates confidence
levels that guide decision-making.
3. Empowering the healthcare workforce
Efforts to digitize and standardize healthcare also stem from the global gaps in staffing resources and shrinking budgets. The re-allocation of care staff and expansion of roles that were started decades ago were exacerbated during the crisis phase of the Covid-19 pandemic. Care management and team-based responsibilities as well as more data-driven roles are now commonplace.
While these can temporarily address workforce shortages, they do not address the deep burnout that many clinicians are now reporting. Doctors, nurses and other frontline clinicians in some countries have left the profession at alarming rates. In England, NHS hospitals, mental health services, and community providers are now reporting a shortage of nearly 94,000 full-time staff, one in ten posts being vacant in nursing. [3]
Future-based workforce strategies will have to keep pace. The challenge will be to architect new models that foster retention, career development, and restorative self-care – not to mention all-new areas such as teaching soft skills that are increasingly important with new delivery options and care models. But technology also competes with other budget needs within hospitals, and within the IT budget, priorities need to be appropriately assessed and ranked in terms of their potential return on the quality of care provided to patients.
For care delivery, clinicians will have to reinforce their competence with new tools and technologies – from telehealth and remote patient monitoring to how to access, analyze, and use data gleaned from electronic health records and a host of other data sources. Clinicians should also be supported to develop their soft skills and competence with technology for future understanding of how to interact effectively to meet their own needs and those of patients. For on-the-job training, as artificial intelligence becomes more refined and its use expands, algorithms could surface insights much earlier that generate mini-lessons, clinical updates, remediation, and reminders within existing workflows. Used correctly, technology can drive more-efficient care delivery and workforce training.
About Wolters Kluwer
Wolters Kluwer provides trusted clinical technology and evidence-based solutions UpToDate®, Lexicomp® and Medi-Span® that drive effective decision-making and outcomes across healthcare. https://www.wolterskluwer.com/en/health
Reference
- STM Global Brief 2021,
- Ioannidis, J.P.A., Stuart, M.E.,
Brownlee, S. and Strite, S.A. (2017), - The King’s Fund. 23 February 2022.
