Does Decision Support Make Docs Look Dumb?
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One way to overcome patients’ aversion to decision-support technology is to focus on tailored incentives, communications, and programs, says M. Courtney Hughes, PhD, a researcher who studies EBM and technology and founder of Approach Health, a consulting firm in Chicago. Studies show personalized health information is more effective than general, one-size-fits-all solutions—and these are best facilitated with technology such as new communication tools, patient portals, point-of-care decision-support tools, and on-demand, real-time data.
As technology evolves, it will take advantage of patients’ desire for personalized care by using behavioral psychology to motivate patients in trouble areas such as medication adherence, Hughes says. Technology could help providers understand not only a patient’s medical history, but also his
or her past behavior and guide the physician as to the
best strategies to get that patient to comply with
Certain people respond better to certain modes of communication about their adherence, for example. If a patient has a serious condition or comorbidities and a risk for nonadherence, then a face-to-face visit makes sense economically, she says. But simple e-mail reminders might be the best course of action for a new patient with fewer risk factors. Diagnostic tools will someday help physicians to determine what method works best for each patient.
Eventually, it won’t matter what patients think—EBM data and decision-support tools will be increasingly embedded into EMRs. “Patients won’t even be able to tell whether their doctor is using a computer in their diagnostic decision or not,” Wolf says. “In that way, it will become more like the autopilot used on commercial planes. When we fly, we do not see what is happening in the cockpit, so we don’t mind that computers are actually doing most of the flying.”
Regardless of whether patients embrace decision-support tools, physicians must do so, says Joel Diamond, MD, a family practitioner based in Pittsburgh. It’s impractical and inefficient for physicians to step out of the room every time they need to look up something in a journal article or other text resource, all the while getting further and further behind in their schedules.
Payers will also drive decision-support technology, Hughes says.
“Employers and insurers are really motivated to lower costs, and one of the best ways to do so would be to use technology and really put evidence-based medicine and technology together moving forward. The sheer drive in the market will make it happen. Because it has to,” she says.
G. Daniel Martich, MD, CMIO at the University of Pittsburgh Medical Center, agrees that widespread adoption by physicians and their patients is inevitable.
“It’s too late now to say ‘if we should have technology.’ Evidence-based medicine will not work without technology driving it. It’s impossible. Doctors cannot rely on pulling out the New England Journal of Medicine and reading it and somehow applying that to their patient population. It’s not going to work [without full-blown adoption],” he says.
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