Clinical Decision Support with Lacy Fabian, PhD

Musings That Matter: Expansive Thinking About Humanity's Problems

Musings That Matter is a new series to showcase what people are doing to effect change in society. This first one showcases work that I was doing before US Federal priorities shifted. If you’d like to participate in an upcoming article, message me.

Each post endeavors to:

imagine something better, magnificent even

generate ideas to act now

create dialogue to advance our thinking

sow a collective to keep working the problem.

They are not designed to capture every aspect of a problem space or explore every caveat to possible solutions.

They are designed to encourage creative thinking and dialogue. As a reader, 1) connect with the interviewee if you can help with their needs or have another idea, 2) reach out to me if you are working a problem and would like to participate in the series, and 3) be empowered to confront change where you have an opportunity to operate in solidarity with humanity.

What problem is the person facing? (see graphic)

• Healthcare—which requires many needs are met to receive care.

What part of the problem are you trying to solve? (see highlighted path in graphic)

• Healthcare quality through clinical decision support, specifically developing patient-centered support that gets patients the latest healthcare evidence they need at the point-of-care to make decisions about their care.

How are you meeting this need?

• By including patients in the design and implementation of clinical decision support.

What do you need to better meet this need? (see outlined box in graphic)

• Iterative development of clinical decision support with patients.

• Trust in the processes and systems that translate evidence into clinical decision support and then into electronic health systems.

• Business model to scale the development of standards-based clinical decision support that is patient-centered.

What support do you need one layer in and out from where you are trying to solve the problem?

• One layer closer to the patient, I need clear input from the clinical community on what they need from clinical decision support and how they want to use it when receiving care.

• One layer further away from where I’m operating, I need government and healthcare industry collaboration to define and use standard systems for ingesting clinical resources.

What does it look like to the outside observer?

• A complex space—lots of disjointed efforts tackling different parts of the problem, which creates confusion on how to collaborate to scale efforts. For example, clinical decision support lacks a clear business model within its space because it typically exists far away from the people it serves, which means others are likely to be the stewards and funders, so including patients in the design is difficult. Maybe AI companies should play a role given the use of technology to create clinical decision support and the need for trust (such as data ownership considerations)?

What can someone do today for long-term activism?

• As a patient, advocate for access to high-quality care by asking what other treatment options are available or what drove the single option presented.

• As a provider, advocate for your patients’ and professional needs to have access to rigorous clinical decision support.

• As a person behind the scenes, whether operating the health system or publishing medical evidence, advocate for collaboration that elevates quality within the healthcare system.

What magnificence can we imagine?

• People are receiving the latest evidence at the point-of-care to make decisions about their health care.

• People are iteratively involved in a trusted, standards-based process to develop the clinical decision support they need.

• The clinical decision support is informed by the latest best practices in science and technology to implement efficiently and effectively into healthcare systems.

What’s next for You?

• Given shifts in US federal priorities, identify where this work is still happening to create scalable collaborations across the healthcare space.

Want to learn more? Check out this Open Access article: Nothing for Me or About Me, Without Me: Codesign of Clinical Decision Support - 2022 - van Leeuwen - 2022 - Applied Clinical Informatics. Thieme Open Access