Other industries can help improve decision support in healthcare
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Helen W. Wu, MBA, doctoral fellow in policy analysis at the Pardee RAND Graduate School in Santa Monica, Calif., and colleagues reviewed articles covering decision support in the basic sciences, social sciences, humanities, engineering, business and defense. Reviewed articles had to provide a review, overview, discussions of lessons learned or evaluation of design or implementation aspects and involve an element of human judgment at the individual level.
The authors found that "clinical decisions share some similarities with decisions made by military commanders, business managers and other leaders: they involve assessing new situations and choosing courses of action with major consequences, under time pressure and with incomplete information." They identified seven high-level decision support system design features that could be applied to clinical decision support (CDS):
1. Providing broad, system-level perspectives;
2. Customizing interfaces to specific users and roles;
3. Making the decision support reasoning transparent;
4. Presenting data effectively;
5. Generating multiple scenarios covering disparate outcomes (e.g., effective; effective with side effects; ineffective);
6. Allowing for contingent adaptations; and
7. Facilitating collaboration.
Complex, high-level decision-making has common features across disciplines as seemingly disparate as defense, business and healthcare, according to the study. "While both clinical and non-clinical decision support systems have faced implementation challenges, lessons learned from other disciplines, particularly those in which decision support use is more widespread, could inform efforts to advance the adoption of CDS."
Although the content of decisions varies across disciplines, the nature of the decisions and the decision support tools used to inform them may have similarities. For example, clinical and military decision making seem quite different at first glance but in reality, the two groups both make decisions that:
1. Are urgent and require a quick initial response;
2. Require rapid adaptation to changing circumstances and new information;
3. Have life-or-death consequences;
4. Have uncertain responses from opponents/adversaries due to incomplete, imperfect information and unpredictable behavior; and
5. Require an understanding and ability to synthesize the interaction of various risks.
The authors also found two overall themes related to implementation. One is the need for continual system improvements, and the other is effective user training that addresses individual and organizational issues during adoption. "Although these are not new lessons for CDS research, their recurrence in non-clinical decision support research should strengthen them as a priority in CDS."
Beth Walsh,
Editor
Editor Beth earned a bachelor’s degree in journalism and master’s in health communication. She has worked in hospital, academic and publishing settings over the past 20 years. Beth joined TriMed in 2005, as editor of CMIO and Clinical Innovation + Technology. When not covering all things related to health IT, she spends time with her husband and three children.