Doctors Control Panel Perspective
From the perspective of a provider of decision support software (DSS), holy nirvana would be -
1. The ability to create customised rule sets for the purpose of analysing specific medical history items, abnormal pathology results and measurements in the context of all available clinical information.
2. Display summarised decision support guidance.
3. Allow user to drill into the analysis to receive and provide additional information (additional information provided feeds back in to the analysis loop).
4 Ability to store the additional information and results of user determined actions in the clinical file, ideally in standardised format. Standardisation allows clinical software and other vendors having access to data to utilise the stored information at any stage in the future as more decision support is included in various products. And probably most importantly this information becomes part of the clinical record.
We already have the first three items covered.
What is sorely lacking is the last item, and it is hindering trail blazers and indeed interested clinicians in providing clinical utility and functionality.
At present, decision support analysis can only go so far by detecting past history of Hep C, previous antiviral medications, serology tests e.g. viral load.
Specifically for hepatitis C, investigation, staging and tracking of disease status should be analysed and displayed, summarising information stored in the clinical file and optionally allowing the clinician to update the information. What information?? All information required in the investigative and management pathways so that a visual representation can be built which can guide the clinician on completing the pathway.
Recording information could be as simple as having appropriate past medical history coded items to represent information e.g. 'Declined Referral for Hepatitis C clinic', 'Hepatitis C treatment declined by hepatologist' , 'Hepatitis C Viral load undetectable post treatment'.
Alternatively an external list of pathway items could be maintained in a repository and downloaded by clinical software.
In fact the Doctors Control Panel software (DCP) already includes some logic in its generation of GP management plans in the context of hepatitis C, to request information be recorded in the plan to clarify status and management of hepatitis C.
We have shied away from more in depth decision support, not through lack of interest, nor fear of getting it wrong, but simply though lack of the appropriate feedback loop within software to facilitate enhancing the medical record with information valid to decision support pathways.
There is potentially an explosion of decision support that could occur with the correct infrastructure in place.
Dr Anton Knieriemen