Over the past decade or so, the U.S. healthcare system has transitioned from paper-based documentation of patient records to the use of electronic health records (EHRs). One might assume that computerized health records and systems would result in dramatically improving the efficiency and quality of care. The outcome isn’t so cut and dry.
While some efficiencies have been achieved with EHRs, a recent survey showed that fewer physicians believe that use of an EHR has facilitated improved treatment decisions (46 percent in 2015 vs. 62 percent in 2012). What about improvements in the quality of care? We know that overuse of antibiotics is a problem of global proportions, resulting in increased antibiotic-resistant organisms making it more difficult to treat certain infections. Another study demonstrated that patients with viral upper respiratory infections (the common cold) receive inappropriate antibiotic prescriptions 65% of the time. And a third study found antibiotic guideline adherence rates for treating sinus infections were just 43%. This is in spite of the many tools in EHRs that are supposed to assist with improving the quality of care. So how can we improve?
That’s where effective clinical decision support – and the Zipnosis platform – come in.
Clinical Decision Support Boosts Care Quality
There are many ways to improve the quality of care. One approach is akin to a pre-flight checklist. When we fly in an airplane, we trust that the pilot is using a checklist to make sure everything on the plane is working properly before take-off. “Engines, check. Wings attached, check.” We would be less comfortable if our pilot relied only on their experience and intuition and skipped the checklist.
In healthcare, the equivalent of a pre-flight checklist is used less often than you would expect, with busy clinicians sometimes relying solely on their experience and intuition, which is often very good. However, a clinical checklist approach includes tools which clearly spell out best practice guidelines based on the current scientific literature. Health professionals do their best to keep up on the latest studies, but no single human can manage to wade through the estimated 2.5 million scientific articles published each year – in the English language alone. However, one form of clinical decision support includes summarizing relevant clinical guidelines and providing the best practices to clinicians at the time they are making treatment decisions.
To ensure that the clinical decision support (CDS) is effective, it is necessary to be able to measure the rates of clinician guideline adherence to determine if care provided followed the established best-practice standards. Studies have shown that when specific CDS features were used, clinical guideline adherence was significantly improved. Overall, internal analysis of visits through the Zipnosis platform, where CDS is incorporated into the diagnosis and treatment process, have shown a guideline adherence rate of 94%. In my doctoral research, implementing clinical decision support, along with other educational interventions, resulted in an increase in guideline adherence of 3.3% for treatment of sinusitis, from 95.2% to 98.4%.
Clinical Decision Support Meets Virtual Care
At Zipnosis, we help providers improve the quality of care they deliver. Our proprietary protocols are grounded in national best practices, and offer built-in CDS.
The process starts with an adaptive patient interview that systematically captures the appropriate patient symptom history by asking the same questions that would be asked in a face-to-face visit – except the software never forgets a question.
This history is then summarized and presented to the clinician, along with curated diagnosis pathways and treatment options enhanced by CDS in the form of clearly summarized guidelines and best practices. This reduces the variability in diagnosis and treatment, which in turn, results in higher rates of guideline adherent diagnosis and treatment.
Health systems can effectively track guideline adherence through the Zipnosis platform, too. Both the patient history and the diagnosis and treatment plan are stored as structured data, allowing for efficient and accurate quality reporting. At any point, our Statnosis™ real-time analytics platform allows clients to easily report on how well clinical providers adhere to the best practice guidelines.
Achieving Adherence with Zipnosis
Let’s look at a real-world example. Remember the not-so-impressive statistic above – inappropriate antibiotic prescriptions for the common cold 65% of the time? In an analysis of over 1,700 virtual care patient visits for upper respiratory infection symptoms from two large health systems, adherence to best practice guidelines was achieved in over 95% of the cases. At Zipnosis, we take the issue of appropriate antibiotic use very seriously. We saw the need to do better, and we did.
High quality care that is safe, effective and adheres to best practice guidelines can and is being be achieved in the virtual care setting. And the outcomes exceed the quality of care the more traditional face-to-face setting represented in the study above.
Providing quality care is vital – as healthcare practitioners, it’s our job. Ideally, there should be no differentiation in quality standards based on the setting (virtual care versus in-person care). The quality of care is good or it is not and Zipnosis helps health systems meet the highest standards of healthcare today. Quality care – check!
About the Author
Kevin Smith, Chief Clinical Officer at Zipnosis, has been a leader in innovative care delivery since 1999. In both clinical practice and his doctoral studies, he has focused on innovative applications of technology, clinical decision support, and analytics to drive clinical quality improvement. Dr. Smith is adjunct faculty at the University of Minnesota School of Nursing, a Fellow of the American Association of Nurse Practitioners, and a member of the American Telemedicine Association, HIMSS, AMIA, and the National Speakers Association.