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

2022; Oxford University Press; Volume: 30; Issue: 1 Linguagem: Inglês

10.1093/jamia/ocac143

1527-974X

Alan H. Morris, Christopher M. Horvat, Brian C. Stagg, David W. Grainger, Michael J. Lanspa, James F. Orme, Terry P. Clemmer, Lindell K. Weaver, Frank O Thomas, Colin K. Grissom, Ellie Hirshberg, Thomas D. East, C. Jane Wallace, Michael Young, Dean F. Sittig, Mary R. Suchyta, James E. Pearl, Antinio Pesenti, Michela Bombino, Eduardo Beck, Katherine Sward, Charlene Weir, Shobha Phansalkar, Gordon R. Bernard, Bruce Thompson, Roy G. Brower, Jonathon D. Truwit, Jay S. Steingrub, R Duncan Hiten, Douglas F. Willson, Jerry J. Zimmerman, Vinay Nadkarni, Adrienne G. Randolph, Martha A. Q. Curley, Christopher J. L. Newth, Jacques Lacroix, Michael S. D. Agus, Kang Hoe Lee, Bennett P. deBoisblanc, Frederick A. Moore, R. Scott Evans, Dean Sorenson, Anthony Wong, Michael V. Boland, W. Dere, Alan S. Crandall, Julio C. Facelli, Stanley M. Huff, Peter J. Haug, Ulrike Pielmeier, Stephen Edward Rees, Dan Stieper Karbing, Steen Andreassen, Eddy Fan, Roberta M. Goldring, Kenneth I. Berger, Beno W. Oppenheimer, E. Wesley Ely, Brian W. Pickering, David Schoenfeld, Irena Tocino, Russell S. Gonnering, Peter J. Pronovost, Lucy A. Savitz, Didier Dreyfuss, Arthur S. Slutsky, James D. Crapo, Michael R. Pinsky, Brent C. James, Donald M. Berwick,

Health Systems, Economic Evaluations, Quality of Life

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.