Business Solutions: Driving clinical success with point-of-care clinical decision making support

This Business Solutions episode of the podcast features Dr. Richard Loria, physician consultant with EBSCO. Dr. Loria is one of the presenters from our recent webinar, “Using a Point-of-Care Clinical Decision Support Platform to Drive Practice Success,” and he is here to share with our listeners the ways that DynaMed can help clinicians make more efficient, accurate decisions.
 
Editor’s note: The following Q&A has been edited for length and clarity.
 
Q: What is a physician consultant’s role within EBSCO?
 
A: The group of physician consultants is meant to be the voice of the community, working inside the institution to say, ‘What is it exactly we need? What is going to help us get through our day? What is going to help us take care of our patients? What is going to help us live out our vocation to take care of suffering people, but make it home in time to enjoy a family life and those things for which we work so hard? So it's to create a balance. And we're there to say, ‘Please deliver us information in a way that we can use it, and make sure that we're standing on very solid ground so that we're practicing not only at the standard of care, but at the cutting edge of information.’ We want to be the best. And that's what this works. Our job as physician consultants is to be on the inside helping the company deliver the best to the practicing clinician.
 
Q: What are the main inefficiencies or challenges in point-of-care clinical decision making that warrant the need for support?
 
A: Too often, (clinicians are) extremely focused on staring at the computer; we're looking at the technology to the detriment of the patient. The really important information is conveyed not just with words, but with expressions, with how the patient's moving. And we miss these important cues when we're staring at a computer screen. So I think we can't lose focus of the patient, we have to keep the patient front and center of our attention and all of our activities. Now, that's not to say, we don't need - we absolutely need - the clinical decision support tools. But they're meant for precisely that - to support, not to distract from the very important task of caring for another human being’s suffering. So I think that first challenge requires a lot of effort on our own part. But also it requires tools which are efficient and provide what we need: high quality information succinctly. Look, we don't want to have to extract nuggets of actionable information by digging through tons and tons of superfluous information.
 
A potential second inefficiency or challenge is the distraction of thinking that what we need is not going to be there and that we might have to jump to an alternate platform. We have to be very confident in the platform that we use, that the information is there. … Instead of sifting through every last word on the subject, we provide actionable information. And if you need more, we can reveal that through clicking on study details or linking to primary source literature. So I think there was a book back in the 70s, I think it was called the Making of a Surgeon by William Nolen. And there's an interesting passage in the book depicting a surgeon in the OR. And he asks for an instrument and the scrub nurse hands him that instrument. He looks at it proceeds to throw it across the OR saying, ‘Don't give me what I asked for, give me what I need.’ Well, in a way, this is what DynaMed is doing. They're giving you what you need at the point of care. And if you need more, it's yours for the taking. …
 
The final challenge I would highlight is really documentation. You know the saying goes, ‘If it's not documented, it didn't happen.’ And that's a problem because it means it's on us to document everything that we do that's important. So, a beautiful aspect of our shared decision- making tool in DynaMed, DynaMed Decisions, is that it's going to generate a chart note memorializing our discussion with the patient. And we're simply going to copy and paste that into the note, this is an incredible time saver.
 
Q: Can you share an example of these decision-making tools helping to produce a more accurate or efficient decision?
 
A: At a conference I attended recently, we discussed the fact that one of the individuals attending the conference had suffered a misdiagnosis. So our differential diagnosis tool, Isabel, he wanted to put it to the test, and see whether or not this could indeed pick up what he had. And so by simply plugging in his demographic, a male 30 to 39, painful left arm, one starts thinking myocardial things, but he had a cold. And so just plugging in to symptoms, painful left arm, cold hand, we came up with a differential diagnosis to include Thoracic Outlet Syndrome, which is exactly what he has. And he was shocked at the accuracy. And in fact, the differential diagnosis tool on our platform has an accuracy of 96%. And again, considering that misdiagnosis is responsible for 15% of all harm that occurs to patients, this becomes extremely important not just to take care of people, but to really protect our practices and our institutions.

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The MGMA Insights podcasts are produced by Daniel Williams, Camille Burch, and Rob Ketcham. 

Sponsor:
 
MGMA Events: This episode is brought to you by the Medical Practice Excellence: Financial and Operations Conference 2023. During our premiere spring event, attendees will gain key insights from both disciplines and learn about topics that shape the future success of medical practice organizations.

Humana: The latest Value-Based Care Report from Humana outlines many interesting findings and highlights how some physician practices found creative paths to success. Check it out now at Humana.com/VBC. Humana is working closely with physician practices on their value-based journeys.

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