Clinical decision support (CDS) is not new. I trained pre-laptop and pre-Internet. For me, clinical decision support was a ring-bound Washington Manual (remember that, guys?). I remember sitting at the nursing station, Manual open to the appropriate page, writing my admitting orders—by hand, of course. The Manual was the Intern’s Bible of its day.
Now, of course, CDS is all about having the information at your fingertips with the click of a mouse. Decision support is built into EHRs, sometimes to the annoyance of the clinician unable to go further without responding to a box asking questions like “Are all the patient’s immunizations up-to-date?” CDS is also available via apps and platforms on hand-held devices being used at the point of care. Docs no longer have to excuse themselves to go look up a dose in the ponderous PDR stashed on a bookshelf in their office. If Google glass or its successor(s) get widely used, CDS will undoubtedly be embedded there as well.
The right content at the right time
CDS is all about the right content at the right time…and in the right amount. You don’t want to wade through mounds of information to get the tidbit you need in order to write the prescription or arrange the proper follow-up.
So I was really interested to learn what Elsevier, the purveyor of many fine medical books and journals (too many hidden behind a paywall though), is up to with their CDS product branded as Clinical Key. Peter Edelstein, MD, their Chief Medical Officer and former trauma and cancer surgeon, joined me, at HIMSS to chat on film about their approach. It is actually very interesting and, I think, warrants the label of next generation Clinical Decision Support. In a nutshell, Elsevier is producing clinical content for use at the point of care and beyond that is customized to the user. Although the evidence base is the same, nurses will see content on a topic that includes information from nursing journals; doctors will see content from sources they know and trust (many of them, of course, Elsevier journals and books); and pharmacists will have content customized to their unique needs.
Dr. Edelstein says Clinical Key differs from its competitor, Up-to-Date because their content targets not only PCPs, but also specialists. And, he says that patients get content that reflects their needs at the time—all in the right language and at the right educational level. He says they also have “millions” of videos to draw from.
Full disclosure, I have not used Clinical Key in a clinical setting myself, but I did sign up for a free trial and you can, too.