Clinical Decision Support Tools
Author: Dr Jaisun Vivekanandaraja
An Article by Dr Jaisun Vivekanandaraja GP Partner, Clinical Lead for Planned Care and IT, Greenwich, SEL CCG
During this COVID-19 pandemic, general practice has seen a lot of changes in terms of how information technology (IT) has been used to deliver patient care. There was a time when we were having discussions about the pros and cons of e-consulting and video consulting. Overnight it seems, we switched over to these alternative methods of consulting. At present, telephone consulting is the default mode when it comes to assessing our patients.
The change to telephone consulting has not made our lives easier. There are more steps involved, often with further inputs following a telephone consultation, such as texting back of images, converting to a video call, or bringing in the patient for a face-to-face assessment.
Due to these massive changes in the way we have started consulting, decision support tools can be invaluable in helping to make our working lives easier.
One such example, is a tool that sits alongside the clinical system to help communicate with our patients via text messages or helping to convert to video calls. The text message can be an extremely efficient way of one-way communication or two-way communication where we need to get information from the patient. The clinician is able to decide how the communication is done. The system can allow for the information to be saved directly into the medical record for medicolegal purposes. It has a feel-good factor of sending some regular reports of how much time you have saved by using such a system.
Referring patients, and the referral process generally, is one area where decision support can really add value and save all practice staff time and add efficiency. There was a time when a provider would change their phone number or email address used for referring. The process was rather convoluted. The provider will inform their new phone number or email address to the CCG/commissioner. The commissioner will then send an email or communication to the communications team. In turn, they will forward the details to the practice manager. There are times when this will be directly communicated to the clinicians if they already hold the details. If this is not the case, the practice manager will then dissipate the information to the whole practice. If you are unlucky, you will get 2 emails or sometimes 3 emails about the same thing. In our busy lives, do we want to be looking at 3 emails related to a change in email or phone number for a service that we may not even use for a number of months?
It doesn’t stop there! Once the manager emails the details, the practice admin staff must go through the process of deleting the old form and updating the new form with the email address/phone number. Sometimes the old form is left on the clinical system. The result is that a clinician inadvertently uses this form and sends a referral to the wrong email address, which results in unnecessary delay.
All of the above steps discussed are no longer required with clinical decision support tools. Up-to-date forms can be uploaded into the system and changes are evident when one searches for the form required. There is no need for admin to remove and add forms. It is all done without the practice or the clinician being aware. DXS BestPathway is a good example of a system that overcomes these problems.
With systems such as DXS BestPathway, it is now possible to break down complex guidelines so that the clinician is able to search using a simple search bar and get to the most relevant section without having any delay. It can ensure that we make the correct referrals to the correct clinic, using the correct method such as email or via electronic referral system (e-RS).
For locums and clinicians not familiar with local pathways, it enables them to search and find the most relevant information in the area that you are working in. Currently, there is one clinical commissioning group within South East London, however, there are differences within this large area. The support tools can help to break this down so that the patient takes the right path to recovery.
As GPs we often prefer the ease of using referral letters, but this is a false benefit because it leads to wasted time further down the referral line. Referral forms can sometimes be complex, however, they do help the provider to ascertain the best course of action. It can also help the referrer by including the most relevant information to avoid the referral being returned to the referrer to ask for more information. In the long run, it makes it smoother for the patient and all involved.
Clinical decision solutions have the ability to rapidly deploy aides when they are needed most. A recent example is the ever-evolving management of COVID-19, with services being commissioned according to need. To help guide this process, I have come up with a single page that has an arrow from left to right indicating the services available from the start of COVID-19 symptoms/diagnosis. Along this arrow, the appropriate services are visible with a hyperlink to open up relevant forms. All I am expecting the clinicians to remember, is this single page. With time, some services may stop and will be removed from this page along with the form. Any new services added will be visible. In addition, services in the pipeline are also visible, so there is an awareness of what may be available in the future. This simplicity is likely to reduce stress in what are often very difficult environments that we work in.
If systems are intuitive and user-friendly, it can really help the uptake of its use and make life easier. I have come across senior GPs who have really taken to the IT system which enables texting and video calls due to the ease of use. There is no training needed; I personally refer to it as a WYSIWYG system (WYSIWYG – what you see is what you get!). If more systems remember the end-user when designing and refining the system, it is more likely to be utilised.
As GPs, we treat patients from cradle to grave. However hard we try; it is almost impossible to be up to date with all topics. The modern GP work involves portfolio careers with varied sessions, often in different health care settings. The decision support tools can be immensely helpful in obtaining knowledge efficiently and ensuring that we deliver the best care for our patients. I for one, feel grateful for such advancements in helping us in our working day as a GP.