New Normal: CDSS Is The New Normal In Healthcare Delivery According To Expert

Any newly adopted standard of behaviour is said to be a ‘New Normal’. Just like wearing a mask now has become the new normal in our everyday life, implementation of CDSS in patient care has now become a new normal in the healthcare sector

Dr. Suresh Viswanathan, Managing Director at SKS Hospital & Postgraduate Medical Institute

What is the new normal in healthcare delivery according to you and how is CDSS enabling it?

Any newly adopted standard of behaviour is said to be a ‘New Normal’. Just like wearing a mask now has become the new normal in our everyday life, implementation of CDSS in patient care has now become a new normal in the healthcare sector. CDSS is the most easy-to-use digital tool for implementing evidence-based clinical practice in hospitals. Evidence-based treatment results in better outcomes and COVID-19 is a prime example to understand this. COVID-19 was a very new disease, and we did not have any prior knowledge to support any treatment regime to manage it. In this situation, CDSS backed up with the authentic and updated information became extremely crucial. There were times when an overload of unverified information around Covid-19 were making rounds, so we needed a system that was efficient enough to provide the evidence-based guidelines and treatment protocols for the healthcare providers. The patients treated under evidence-based practice have a higher chance of survival than those who were treated without it.

Adoption of CDSS is still at a very nascent stage in India. Healthcare practitioners are still following traditional approach for patient care. However, we have received positive feedback from our all our doctors who have become enthusiastic about UpToDate CDSS. They have campus-wide access, which means clinicians can connect to any devices, be it their phones, personal laptops, and on ward computers when they are on the rounds. With our institutional subscription to UpToDate CDSS, it was observed most of our doctors started using it as a voluntary practice after getting exposed to it. They even bookmark topics to read later which they can access off campus with their login.

What are some of the clinical challenges across hospitals/clinics in smaller cities & towns?

With higher internet penetration and smartphones, patients now Google their symptoms and arrive at a “diagnosis”, and possible medication even before meeting a doctor. Yes, this makes them aware to an extent, but does not make them an expert in that domain. Therefore, it becomes difficult for the clinicians to make the patients understand that all the information available on internet cannot be applied to them. Another challenge that smaller cities face is that they are always competing with the metro cities. People tend to have a pre-conceived notion that Tier 2&3 cities lack quality medical care as compared to a Tier 1 city. However, there are specialists and super specialists in smaller cities too, but the perception that undermines the quality of care in smaller cities is largely prevalent. Hence, smaller cities have an added task of retaining the patients.

Another challenge is the cost aspect in Tier 2 and Tier 3 cities. To optimize the cost, hospitals in non-metro cities tend to skip the implementation of digital tools during care as these tools are usually subscription based. Countries like UK and US gets the subscription of tools like CDSS by their government or institution as a mandatory process. Here in India, especially the private players in the Tier 2 and Tier 3 cities have zero cost allocation for such tools. However, the cost of CDSS should be kept sacrosanct much like how the hospital pays for electricity or internet connection. Last, yet a major challenge faced by hospitals in the Tier 1 & 2 cities is the use of paper for medical records. Keeping the record of clinical data on paper makes the clinical workflow cumbersome. This not only leads to redundant processes and unnecessary repetition of data but also yields to the loss of time. Not every clinician has an assistant doctor with him who can provide all the information about the patient.

To what extent can CDSS address these challenges to optimise and standardise healthcare delivery?

When laparoscopy was introduced, it was expensive and not everyone could afford it. Later, it outdated open surgery and became a standard practice. Similarly, Cath labs emerged out as an expensive equipment, but made a shift in the treatment and later became a standard practice for treatment of heart patients. I see CDSS in the similar lines. The number of patients who benefit from CDSS and the reduction in cases of medical errors due to CDSS justifies the subscription cost. CDSS proves to be one of those weapons that help standardise and optimise care. As CDSS comes extremely handy to elevate the clinical practice, it enables personalised medicine that benefits patients with improved clinical outcomes. In a critical care unit, CDSS helps with the assessment of a patient and planning their treatment procedure, which essentially reduces the chances of medical errors. It is designed to get precise and practical answers for physicians at the point of care.

In addition, when CDSS is integrated into EMR, the healthcare delivery becomes even more hassle free, including easier access to information. One does not have to look up for previous patient information or type in queries repeatedly. A single click can take the clinician to clinical topics across specialties. Even junior doctors can access the latest treatment modality through CDSS. For instance, if something comes up during the night, junior doctors will be equipped to manage the situation by looking at the current guidelines for that treatment modality. I strongly believe if you’re a practitioner and not using CDSS, then you’re doing a disservice to your patients.

CDSS can also help in medical legal cases, as an evidence. Let’s understand that the job of a medical practitioner is always on the knife edge, which includes a constant threat of being sued, even if they think they are doing everything correctly. In those cases, if the legal counsel asks for the evidence, one can put forward the fact that they used CDSS as a standard of care, per the latest updated information and show proof. Therefore, using CDSS on an institutional level, is a carrot and the stick method. The carrot is improved outcomes, better utilization, and the stick is more protection from medical legal issues.

What is the level of adoption and awareness for CDSS in smaller cities among clinicians and hospitals at large?

From my observations, the awareness for CDSS in smaller cities is quite good. Furthermore, during this pandemic, COVID-19 resources was made available for free by UpToDate in public interest, which has exposed a lot more users to the convenience and advantage of CDSS. However, since institutional subscriptions are rare, those who can afford it, go in for individual subscriptions, which they often end up sharing amongst junior doctors and colleagues. However, this comes with its own caveats – one of the important features of a CDSS is the ability to bookmark relevant topics and also set alerts when there’s an update on the user’s choice of topics. If a single account is shared, all these preferences comingle and become irrelevant. With an institutional subscription, everyone gets their own login which they can personalise.

Why should clinics/hospitals in non-metro leverage CDSS and what advantage will it provide them?

Healthcare is rapidly evolving and with each new edition, textbooks are becoming larger, often running into multiple volumes. It becomes challenging for clinicians to keep up with the changing disease profiles and overload of information. While patients have better access to medical care due to technological revolutions, it is critical for doctors to have advanced platforms that offer convenience and precision. Hence CDSS, as a key digital platform, plays a crucial role in improving patient outcomes by providing doctors with the latest information in real-time.

Doctors in India are often pressed for time. They see more patients compared to their western counterparts and anything that can make them more efficient without sacrificing quality is to be welcomed. CDSS is just that tool. Time is also critical while treating an emergency that requires an immediate medical intervention. Therefore, the doctors require a platform that would help them retrieve verified and reliable information regarding the disease type and its treatment. Our doctors’ access UpToDate from the desktop, tablet, and mobile app, providing them with crucial just-in-time support.




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