Rob Wake, country manager, Clinical Effectiveness, Wolters Kluwer Health, writes about how Clinical Decision Support (CDS) technology can help the NHS boost efficiency and reduce unnecessary tests.
In 2014, the NHS in England published a report in which it predicted there would be a £30 billion mismatch between resources and patient needs by 2020/21. In response, it set itself the target of introducing annual savings of £22 billion a year, with the remainder to come from additional funding.
As 2020 draws near, it is clear that the NHS has found it challenging to deliver this level of efficiencies. Solutions are hard to find, but an area of technology, called Clinical Decision Support (CDS), is attracting increasing interest.
Already well-established in many health services around the world, CDS technology solutions help clinicians make more accurate, evidence-based decisions at the point of care, allowing them to check diagnoses, treatment recommendations and drug choices.
Reducing errors boosts efficiency
Faster, more accurate decision-making enabled by CDS has been shown to greatly boost efficiency by reducing unnecessary tests, inaccurate prescriptions of drugs and referrals to A&E that could have been more effectively managed in a different care setting. They have also proved effective in filtering out misdiagnoses, another area which has significant cost implications in terms of wasted time and resources for the NHS.
A good example of CDS technology in action is Wolters Kluwer’s UpToDate, a pioneering solution that provides evidence-based information and treatment recommendations on 10,500 conditions across 25 specialities. Based on the most recent information that has been peer-reviewed and collated by over 6700 doctors and clinicians, it is now used by 1.5 million doctors around the world, with 43 million topics searched on it every month.
There is evidence to back up the positive impact of the solution. Researchers at Harvard, for example, have calculated that its use can reduce length of stay by 0.167 of a bed day per inpatient, saving a typical large teaching hospital £2.2m annually or 9,000 bed days. Similarly, [ii]a pilot project at Leicester General Hospital found that the introduction of CDS Technology helped reduce prescribing errors by 50 percent.
As for the potentially devastating issue of misdiagnoses, [iii]a 2018 Japanese study found that physicians who use UpToDate have a significantly lower rate of diagnostic errors compared to a control group without UpToDate (2 percent versus 24 percent).
Catching on in the NHS?
Findings like these explain why UpToDate is being deployed by a growing number of NHS Trusts, including 12 out of 17 that have been identified as Global Digital Exemplars by NHS Digital. Customers include Barts Health NHS Trust; East Cheshire NHS Trust, Shrewsbury & Telford Hospital NHS Trust, University Hospitals Birmingham NHS Foundation Trust; University College London Hospitals NHS Foundation Trust and Betsi Cadwaladyr University Health Board (Wales’ largest health organisation).
While CDS technology is playing its part in helping the NHS tackle its efficiency targets, it’s clear that always-on access to accurate diagnosis is also a welcome support for doctors who increasingly under the spotlight for their decision-making. The cost of mistakes is [iv]hitting the headlines more frequently, increasing the pressure on clinicians even further. Fear of litigation is another contributing factor.
In the UK, doctors are able to access across desktop and mobile devices. Feedback shows they can provide patients with instantaneous, trusted decisions and information sheets, building higher levels of trust and reassurance.
Critics might argue that there is a risk in doctors becoming too reliant on CDS technology. But the reality is that these tools work precisely because they are being used by people with the experience to interpret the data quickly and effectively. It’s the combination of expert professional knowledge and expertise and current, verified clinical information that has meant efficiency is being achieved – but not at the expense of patient care.