Computer clinical decision support that automates personalized clinical care: a challenging but needed healthcare delivery strategy

Author:

Morris Alan H12ORCID,Horvat Christopher3,Stagg Brian4,Grainger David W5,Lanspa Michael2,Orme James12,Clemmer Terry P6,Weaver Lindell K2,Thomas Frank O1,Grissom Colin K2,Hirshberg Ellie2,East Thomas D7,Wallace Carrie Jane2,Young Michael P8,Sittig Dean F9ORCID,Suchyta Mary2,Pearl James E12,Pesenti Antinio10,Bombino Michela11,Beck Eduardo12,Sward Katherine A13ORCID,Weir Charlene14ORCID,Phansalkar Shobha15,Bernard Gordon R16,Thompson B Taylor17,Brower Roy18,Truwit Jonathon19,Steingrub Jay20,Hiten R Duncan21,Willson Douglas F22,Zimmerman Jerry J23,Nadkarni Vinay24,Randolph Adrienne G25,Curley Martha A Q26,Newth Christopher J L27,Lacroix Jacques28,Agus Michael S D29,Lee Kang Hoe30,deBoisblanc Bennett P31,Moore Frederick Alan32,Evans R Scott33,Sorenson Dean K34,Wong Anthony35,Boland Michael V36,Dere Willard H37,Crandall Alan438,Facelli Julio14,Huff Stanley M39ORCID,Haug Peter J33,Pielmeier Ulrike40,Rees Stephen E40,Karbing Dan S40,Andreassen Steen40,Fan Eddy41,Goldring Roberta M42,Berger Kenneth I42,Oppenheimer Beno W42,Ely E Wesley4344,Pickering Brian W45,Schoenfeld David A46,Tocino Irena47,Gonnering Russell S48ORCID,Pronovost Peter J49,Savitz Lucy A50,Dreyfuss Didier51,Slutsky Arthur S52,Crapo James D53,Pinsky Michael R54,James Brent55,Berwick Donald M56

Affiliation:

1. Department of Internal Medicine, University of Utah , Salt Lake City, Utah, USA

2. Department of Internal Medicine, Intermountain Healthcare , Salt Lake City, Utah, USA

3. Department of Critical Care Medicine, University of Pittsburgh , Pittsburgh, Pennsylvania, USA

4. Department of Ophthalmology and Visual Sciences, Moran Eye Center, University of Utah , Salt Lake City, Utah, USA

5. Department of Biomedical Engineering, University of Utah , Salt Lake City, Utah, USA

6. Department of Internal Medicine (Critical Care), Intermountain Healthcare , Salt Lake City, Utah, USA

7. SYNCRONYS - Chief Executive Officer , Albuquerque, New Mexico, USA

8. Department of Critical Care, Renown Regional Medical Center , Reno, Nevada, USA

9. School of Biomedical Informatics, University of Texas Health Science Center , Houston, Texas, USA

10. Faculty of Medicine and Surgery—Anesthesiology, University of Milan , Milano, Lombardia, Italy

11. Department of Emergency and Intensive Care, San Gerardo Hospital , Monza (MB), Italy

12. Faculty of Medicine and Surgery - Anesthesiology, University of Milan , Ospedale di Desio, Desio, Lombardia, Italy

13. Department of Biomedical Informatics, College of Nursing, University of Utah , Salt Lake City, Utah, USA

14. Department of Biomedical Informatics, University of Utah , Salt Lake City, Utah, USA

15. Wolters Kluwer Health—Clinical Solutions—Medical Informatics, Wolters Kluwer Health , Newton, Massachusetts, USA

16. Vanderbilt University School of Medicine , Nashville, Tennessee, USA

17. Pulmonary and Critical Care Division, Department of Internal Medicine, Harvard Medical School , Boston, Massachusetts, USA

18. Department of Medicine, Johns Hopkins School of Medicine , Baltimore, Maryland, USA

19. Department of Internal Medicine, Pulmonary and Critical Care, Medical College of Wisconsin , Milwaukee, Wisconsin, USA

20. Department of Internal Medicine, Pulmonary and Critical Care, University of Massachusetts Medical School , Baystate Campus, Springfield, Massachusetts, USA

21. Department of Internal Medicine, Pulmonary and Critical Care, University of Cincinnati College of Medicine , Cincinnati, Ohio, USA

22. Pediatric Critical Care, Department of Pediatrics, Virginia Commonwealth University , Richmond, Virginia, USA

23. Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Washington School of Medicine , Seattle, Washington, USA

24. Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia , Philadelphia, Pennsylvania, USA

25. Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital , Boston, Massachusetts, USA

26. University of Pennsylvania School of Nursing , Philadelphia, Pennsylvania, USA

27. Childrens Hospital Los Angeles, Department of Anesthesiology and Critical Care, University of Southern California Keck School of Medicine , Los Angeles, California, USA

28. Division of Pediatric Critical Care Medicine, Department of Pediatrics, Université de Montréal Faculté de Médecine , Montreal, Quebec, Canada

29. Division of Medical Pediatric Critical Care, Department of Pediatrics, Boston Children’s Hospital, Harvard Medical School , Boston, Massachusetts, USA

30. Department of Intensive Care Medicine, Ng Teng Fong Hospital and National University Centre of Transplantation, National University Singapore Yong Loo Lin School of Medicine , Singapore

31. Department of Internal Medicine, Pulmonary and Critical Care, Louisiana State University Health Sciences Center , New Orleans, Louisiana, USA

32. Department of Surgery, University of Florida College of Medicine , Gainesville, Florida, USA

33. Department of Medical Informatics, Intermountain Healthcare, and Department of Biomedical Informatics, University of Utah , Salt Lake City, Utah, USA

34. Department of Medical Informatics, Intermountain Healthcare , Salt Lake City, Utah, USA

35. Department of Data Science Ann and Robert H Lurie Children's Hospital of Chicago , Chicago, Illinois, USA

36. Department of Ophthalmology, Massachusetts Ear and Eye Infirmary, Harvard Medical School , Boston, Massachusetts, USA

37. Endocrinology and Metabolism Division, Department of Internal Medicine, University of Utah , Salt Lake City, Utah, USA

38. Posthumous

39. Department of Medical Informatics, Intermountain Healthcare, Department of Biomedical Informatics, University of Utah, and Graphite Health , Salt Lake City, Utah, USA

40. Aalborg University Faculty of Engineering and Science - Department of Health Science and Technology, Respiratory and Critical Care Group , Aalborg, Nordjylland, Denmark

41. Internal Medicine, Pulmonary and Critical Care Division, Institute of Health Policy, Management and Evaluation, University of Toronto Faculty of Medicine , Toronto, Ontario, Canada

42. Department of Internal Medicine, Pulmonary and Critical Care, New York University School of Medicine , New York, New York, USA

43. Internal Medicine, Pulmonary and Critical Care, Critical Illness, Brain Dysfunction, and Survivorship (CIBS) Center, Vanderbilt University Medical Center , Nashville, Tennessee, USA

44. Tennessee Valley Veteran’s Affairs Geriatric Research Education Clinical Center (GRECC) , Nashville, Tennessee, USA

45. Department of Anesthesiology, Mayo Clinic , Rochester, Minnesota, USA

46. Biostatistics Center, Massachusetts General Hospital , Boston, Massachusetts, USA

47. Department of Radiology, Yale University School of Medicine , New Haven, Connecticut, USA

48. Department of Ophthalmology and Visual Sciences, Medical College of Wisconsin, Milwaukee , Wisconsin, USA

49. Department of Anesthesiology and Critical Care Medicine, University Hospitals, Highland Hills, Case Western Reserve University School of Medicine , Cleveland, Ohio, USA

50. Northwest Center for Health Research, Kaiser Permanente , Oakland, California, USA

51. Assistance Publique—Hôpitaux de Paris, Université de Paris, Sorbonne Université - INSERM unit UMR S_1155 (Common and Rare Kidney Diseases) , Paris, France

52. Interdepartmental Division of Critical Care Medicine, Keenan Research Center, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, University of Toronto , Toronto, Ontario, Canada

53. Department of Internal Medicine, National Jewish Health , Denver, Colorado, USA

54. Department of Critical Care Medicine, University of Pittsburgh School of Medicine , Pittsburgh, Pennsylvania, USA

55. Department of Internal Medicine, Clinical Excellence Research Center (CERC), Stanford University School of Medicine , Stanford, California, USA

56. Institute for Healthcare Improvement , Cambridge, Massachusetts, USA

Abstract

Abstract How to deliver best care in various clinical settings remains a vexing problem. All pertinent healthcare-related questions have not, cannot, and will not be addressable with costly time- and resource-consuming controlled clinical trials. At present, evidence-based guidelines can address only a small fraction of the types of care that clinicians deliver. Furthermore, underserved areas rarely can access state-of-the-art evidence-based guidelines in real-time, and often lack the wherewithal to implement advanced guidelines. Care providers in such settings frequently do not have sufficient training to undertake advanced guideline implementation. Nevertheless, in advanced modern healthcare delivery environments, use of eActions (validated clinical decision support systems) could help overcome the cognitive limitations of overburdened clinicians. Widespread use of eActions will require surmounting current healthcare technical and cultural barriers and installing clinical evidence/data curation systems. The authors expect that increased numbers of evidence-based guidelines will result from future comparative effectiveness clinical research carried out during routine healthcare delivery within learning healthcare systems.

Funder

NIH

Deseret Foundation, and Intermountain Healthcare, Inc.

Publisher

Oxford University Press (OUP)

Subject

Health Informatics

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