Common Medical Practices Commonly Fail: The Need for Evidence-Based Clinical Decision Support

Guest post by Clyde Wesp Jr, MD and John T. Chang, MD, PhD, MPH, Zynx Health.

For years, physicians would – and many probably still do – advise patients with dust mite allergies to buy allergen-impermeable bed covers to control their symptoms.

The problem: The use of these high-priced linens has no clinical benefit for either allergic rhinitis or asthma, according to studies published in the New England Journal of Medicine.

This is just one example of the overutilization of an ineffective practice in medicine. Indeed, the problem runs rampant, according to a recently published Mayo Clinic study. In fact, researchers identified 146 common medical treatment protocols that offer no net benefits and that either have been or need to be reversed.

Such practices could have unfortunate consequences, according to Vinay Prasad, MD, one of the study’s authors. In a supplemental video to the article titled “A Decade of Reversal: An Analysis of 146 Contradicted Medical Practices,” the oncologist points out that the proliferation of these ineffective practices could cause harm to patients, prompt patients to lose trust in the medical community, and result in unnecessary spending. Just think: Impermeable bedding was once a $26 million industry, according to Prasad.

The Mayo Clinic study, which was based on the analysis of 10 years’ worth of research in the New England Journal of Medicine, is valuable because it opens what we believe is a very worthwhile discussion regarding the value of evidence-based clinical content and clinical decision support (CDS) solutions. Such technology can be utilized to stay on top of emerging best practices and help healthcare organizations improve patient outcomes, enhance safety, and lower costs. By providing such clinical content electronically, healthcare organizations can work toward eliminating the overutilization of ineffective practices and work toward consistently applying standardized best practices at the point of care.

Start talking
Here are just a few considerations that medical professionals need to start thinking and talking about as they consider the need for CDS technology:

#1: Quite simply, why are clinicians implementing treatment plans that don’t work? To start, medicine is based on tradition. Typically, clinicians learn from their predecessors. Thus, many practices and treatment protocols took hold two, three, or even four decades ago. Therefore, these practices could be based on outdated or incomplete evidence. Indeed, some treatment practices came into being when there was absolutely no corroborating evidence. In such cases, clinicians based their decisions on logic and intuition, simply because that is all they had to go on.

#2: Do we see a mentality of “because that’s the way we have always done it” in the healthcare industry? Once the healthcare industry adopts a practice, clinicians seem to hold on to it – no questions asked. According to the Mayo study, only 27% (363/1344) of articles that tested a practice tested an established one. Most of the studies examined were focused on new treatments. While it is important to keep developing new and better treatments, leaders should also take a step back and ask if current practices are effective. As value-based purchasing takes hold in the United States, leaders will need to verify effectiveness more thoroughly, as reimbursement will be based on clinical results.

#3: Are medical professionals ignoring emerging clinical evidence? It’s doubtful that clinicians are purposely disregarding new medical evidence. However, in this Information Age, it’s likely that clinicians are simply overwhelmed by all the new information that they have to deal with day in and day out. Therefore, there is often a significant gap between the time new evidence is published and the time it is adopted. In fact, it takes about a decade for contraindicated practices to fall out of favor.

Asking and answering these questions is a great way to get the healthcare industry focused on the very real problem of the proliferation of ineffective medical practices that leads to unnecessary waste and substandard outcomes. We also believe that the discussion clearly shines a spotlight on the need for advanced technologies, such as those offered by Zynx Health, an evidence-based clinical decision support solutions vendor that helps healthcare organizations measurably improve patient outcomes, enhance safety, and lower costs.

Taking action
Such technologies, in fact, can bring welcome relief to wary clinicians, who need to constantly reassess the body of clinical evidence, update treatment strategies, and then implement new protocols into their daily practices. Indeed, instead of spending inordinate amounts of time trying to research and stay current on all the emerging clinical research, it is much more effective for clinicians to rely upon a technology solution that can bring the evidence-based clinical content and decision support right to them at the point of care.

For example, clinicians can easily access emerging research findings and guidelines that address specific clinical conditions, procedures, and patient problems in ZynxEvidence, an online resource designed to offer best practice information to physicians, nurses, and other professionals. The solution specifically offers clinical recommendations for interventions based on best practices and compliance with major regulatory initiatives and accrediting bodies; article summaries substantiating the value of the recommended approach; and complete references, abstracts, and links to open-access full-text articles.

Just providing the information, however, is not enough. Healthcare organizations also need to ensure that clinicians engage with the information put in front of them. To begin with, organizations should involve clinicians in the governance of change management initiatives. Then, when a new evidence-based treatment is introduced, a clinical leader would need to act as the “champion,” encouraging others in the organization to adopt the new practice. In addition, other clinicians would be involved on committees or task forces that are exploring the change. Such personal involvement will engage the clinicians and the change will become a reality, not a wish.

It’s also important to leverage technology to provide clinicians with easy access to clinical decision support. In essence, clinicians need to be able to tap into the evidence-based information as part of their normal workflow. Solutions such as ZynxOrder enable healthcare provider organizations to customize evidence-based order sets and clinical decision support rules and then integrate this content into existing electronic health record (EHR) systems. As such, clinicians can simply access the content as they traverse the system and as they enter patient orders via computerized provider order entry (CPOE) applications.

By implementing such changes and leveraging CDS technology solutions, healthcare organizations will enable clinicians to access evidence-based clinical decision support at the point of care. Caregivers can make choices based on the most current scientific evidence, rather than tradition or simply intuition. As a result, organizations will be able to eliminate ineffective medical practices. And, perhaps most importantly, they will be able to implement medical treatment that has a positive impact on patient outcomes, safety, and costs.

About the Authors

Clyde Wesp, Jr, MD, is senior vice president and executive clinical strategist at Zynx Health, Los Angeles. Wesp works with members of the C-suite, clinical leadership, and other staff at client sites to develop organizational clinical strategy and to demonstrate how Zynx Health solutions, tools, and services can support strategy through measurable improvements in clinical practice and outcomes.

John Chang, MD, PhD, MPH is the director of clinical content at Zynx Health, Los Angeles.  He is responsible for the development and maintenance of clinical content used in Zynx solutions.  He oversees the methodology, development, and maintenance of evidence-based and experience-based content that improve clinical and financial outcomes. He also assists clients in developing strategies for measuring the improvements in outcomes associated with the use of Zynx solutions.

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