Shahid Akhter, editor, ETHealthworld spoke to Shireesh Sahai, CEO, Wolters Kluwer, Gurgaon, to know more about the impact of Clinical Decision Support in healthcare and how it can impact and even alter a doctor’s decision. Edited excerpts:
How does CDS align with India’s advanced digital capabilities and what is its potential in improving patient outcomes in rural India ?
Clinical Decision Support (CDS) is a key digital tool which helps doctors make better clinical decision as they are treating the patients at the point of care. Just to illustrate, why it is so important? It has been proven by ample research that everyday a doctor when he is treating a patient, he or she faces eleven clinical questions. Unfortunately 60% of these questions go unanswered because the doctor does not have the way to look at the answers to these question. In case these questions were answered, 5-8 patients decision could have been impacted and that is the essence of clinical decision support. Just to highlight Up To Date anywhere which is one of the clinical decision support tool is really something which is answering these questions. It is answering these questions in 90 seconds in more than 25 specialties and answer which is validated by 6000 experts sitting around the world which is three tier peer reviewed and above all it can be had without internet too and that I think is the essence of its relevance for rural India.
How does CDS support PM’s Ayushman Bharat program ?
Ayushman Bharat Program is probably one of the most ambitious program not only for this country but for the world as it covers more than 100 million families in the Rural, Now, how to support or the kick factor for Ayushman Bharat in my view to succeed is 2 fold. First, the cost of giving the treatment has to be considerably reduced. The second is the medical errors or diagnostic errors have to be at the lowest possible, because the essence of Ayushman Bharat is covering of that family by Rs.5 Lakh and that’s why it’s so important and that again brings us to the point that clinical evidence based tool can really play a big role in the success of Ayushman Bharat.
It has already been proven in more than 80 plus researches, I’ll just quote three of them. Firstly, on the efficacy of clinical evidence based tool. Harvard University did a study spread over 3 years and they concluded that hospitals which were using a clinical evidence based tool, like Up To Date, saved 11,500 more lives than the hospital which were not using it. Second is a research which was done by Singapore National University Hospital where the doctors, when treating the patient on the back side, they changed their decision 37% of the time when they referred to a clinical evidence based tool like Up To Date. Last but not the least, just recently a research was published in International Journal of Medical Informatics which concluded that the clinicians who used Up To Date had only 2% of diagnostic error compared to the clinicians who did not use it, had more than 24%. So as you can see with these studies, Ayushman Bharat which is critically dependent on lower cost of care and low medication error can really benefit from an evidence based tool like Up To Date.
Does Hospital Information System (HIS) integrated with CDS help in optimizing over all healthcare expenditure ?
Definitely, Integrating CDS with Hospital Information System drastically has an impact on hospital but I would like to answer it in two ways. It has an impact, both on the hospital and also on the patient. From the hospital stand point it has a drastic impact on reducing the length of stay which is a key indicator of all the hospital track. I would like to quote two studies that were conducted. One revealed to NHS-UK which again concluded that evidence tool like Up To Date when used and integrated with the HR helps to reduce the length of stay. Also the Harvard University study which concluded that 300 thousand days per year was saved when the hospitals were using the same evidence based tool. But more importantly for the patient, I think the significant reduction of close to 22% in medication errors, diagnostic errors which are reduced by use of clinical evidence based tool is, I think, a big half for the patient. Apart from that, the readmission rates all too significantly go down with the use of CDS tools integrated with information systems.
