In a new study by JAMA Network focusing on the effectiveness of Electronic Health Records (EHR), it has been found that the likelihood of a clinician including pertinent patient life context in their care plan rose with the use of clinical decision support (CDS) and EHR integration.
The primary care clinics of two academic medical centers were the sites of the research, and patients filled out a pre-visit questionnaire that prompted their assigned doctor to record relevant red flags in a contextual care box in the note template. Additionally, the EHR integration used passive and interruptive warnings, collected warning signs from the medical record, and suggested pertinent orders. The EHR integration enhanced the possibility that a doctor would include pertinent patient life context in their care plan despite professional usage of the CDS tool did not result in better patient outcomes. Contextualized treatment plans are more likely to improve prospectively established patient outcomes, according to other recently conducted studies.
“This is the first study, to our knowledge, to demonstrate that CDS tools built into the EHR can decrease contextual errors. Just as CDS can guide biomedically focused decision-making by drawing on data from evidence-based guidelines and other forms of research evidence, it can also guide contextually informed decision making by drawing on data specific to the life circumstances and behaviors of individual patients…Contextualized CDS can serve as a corrective to biomedical bias in which clinicians prioritize biomedical information over contextual information, even when they have comparable implications for a patient’s clinical state.”
Earlier studies have shown evidence of the benefits of contextualized CDS. In one case, a patient who missed her hemodialysis had three unnecessary visits to the emergency room due to acute sickness, and no one questioned her about it. It turned out that she was helplessly imprisoned in a circumstance, and a social worker was able to quickly find a solution. The study has a few drawbacks. Although some warning signs, like the quantity of missed appointments, could be dealt with objectively, other outcomes, like a patient’s report of whether they are exercising more, are subject to patient opinion. Coders were unaware of the research group, meaning this constraint shouldn’t affect the outcome. However, because they could determine when they received contextualized CDS, the study group’s doctors could not be blinded.