The Download: NHSE targets digital support for clinicians

NHS England is planning a major push to make electronic clinical decision support “the norm” for clinicians across the country, HSJ revealed earlier this month.

The ambition is one of several key goals being drawn up by NHSE’s transformation director Tim Ferris, according to an internal list of priorities. 

Compared to implementing electronic patient records and shared care records, rolling out virtual wards to help the covid-19 response and investing in artificial intelligence, CDS appears a less glamorous endeavour.

But its importance has been illustrated during the pandemic, when doctors across the world needed swift access to emerging research and advice on how to treat covid-19.

‘Significant minority’ of trusts lack CDS

CDS effectively acts as a digital library to which clinicians can turn for help diagnosing and treating patients. However, many NHS clinicians and hospital departments do not have access to such software.

NHSE describes CDS as “inconsistently deployed between and within providers”, in its list of priorities for the transformation directorate.

Lisa Kean, associate director at Wolters Kluwer Health – which provides CDS for three quarters of NHS trusts, told the Download a “significant minority” of trusts do not use such systems presently.

CDS offers the biggest benefits when it is embedded within a trust’s electronic patient record (EPR). The software can then bring together standard clinical guidelines with data specific to a patient – which helps the doctor to make their decision.

However, Ms Kean said having CDS integrated in the EPR is “the exception rather than the norm” for NHS trusts.

Get clinicians on-board

Little wonder then, that Dr Ferris’ goal is to “develop national standards for the deployment/availability of CDS as well as guidance for the content”. His vision is for NHS trusts to use CDS within their EPRs to improve clinical outcomes and reduce unwarranted variation.

Asked what the biggest challenge will be to realising Dr Ferris’ vision, Ms Kean said: “Getting clinician buy-in.”

She said doctors mainly want to know more about the evidence behind CDS advice, who has created the advice, how easy the software is to access, and how fast they can get answers.

“Having the confidence of the doctors is key,” Ms Kean said.

Once CDS software is integrated with an EPR, the benefits can be plentiful.

“Research shows that clinicians change their mind about a patient’s care 30 per cent of the time,” Ms Kean said. “CDS can confirm that they are making the right decision.”

Between June 2018 and June 2019, data from Royal Liverpool and Broadgreen University Hospitals Trust showed an estimated 7,350 projected decisions were changed while more than 16,000 projected decisions were reinforced after clinicians used CDS.

A study into the benefits of CDS at University Hospitals Leicester Trust has been credited with reducing prescribing errors by paticipating junior doctors by up to 50 per cent.

Grand vision

Ms Kean said the value of CDS had been demonstrated during the pandemic, when studies and journals from around the world were made available to help keep clinicians up to date on emerging trends and treatments.

Other specialties which typically tend to be big users of CDS include nephrology, neuro, endocrinology, pharmacy and anaesthetics, she said.

But the benefits to clinicians offered by CDS stretches beyond those specialties, with Dr Ferris’ vision also including the use of AI.

According to the directorate’s priority document, CDS data standards will “need to incorporate requirements for representative data sets to enable the scaling of AI technologies”, although it’s not yet clear precisely what role AI can play for NHS trusts which have adopted CDS.

Dr Ferris also wants his directorate to work with ICSs to address key issues such as “incentives, training and education support”, and “restrictions and regulatory support”.

In time, the aim is also to give all patients access to “health-related decision support through the NHS App”.

It’s a grand vision. But, like many digital transformations, it must be delivered with clinician buy-in as the main facilitator, rather than a rushed and imposed approach led by the top leadership tier.