A Decision-Support Response to Clinician- Patient Scale Human Limitations

Thu, February 14, 2013 @ 12:00 PM
School of Medicine
Biomedical informatics
HSEB 2110
26 S 2000 E (Google Map Link)
City, State, Zip
Salt Lake City, UT 84112
Jo Ann Thompson
(801) 213-3242
Alan Morris, MD -
Event Audience
Open to Public

The patient-clinician encounter scale involves human-human interactions. While many clinicians participate in healthcare delivery in important ways, it is the physician who is responsible for decisions to generate most interventions. These interventions account for about 60% of healthcare spending. Healthcare spending ($2.7 trillion currently) is crushing the United States. About 1/3 of healthcare spending appears due to unnecessary or ineffective care and is not linked to a credible evidence base. Human (physician and other clinicians) decision making is limited by cognitive constraints that include short-term memory limits to 4±1 constructs, and multiple sources of decision-making bias. Education helps clinician decision-makers better link their decisions to evidence-based care, but education is generally not adequately effective. Computer decision-support tools can contain enough detail to lead different clinicians to the same decision, when dealing with the same patient state or set of patient states. Interestingly, the patient state detail enables these reproducible decision-support tools to generate personalized medicine decision (patient-specific decisions). This is an important observation, but mont intuitive. Homer Warner named such tools "adequately explicit" because they contained enough detail to respond to specific patient contextual variations. eProtocols are adequately explicit decision-support tools that have enabled reproducible clinician decision making and clinical results across institutions, across different geographic sites, across disease management problems, and across cultures.

Dr. Alan H. Morris is professor of medicine and adjunct professor of medical informatics at the University of Utah, and director of research and medical director of the Pulmonary Function and Blood Gas Laboratories at the Intermountain Medical Center and LDS Hospital in Salt Lake City, Utah.

He has experience in the conduct of acute respiratory distress syndrome (ARDS) multi-center randomized clinical trials of treatments, including innovative therapies, for ARDS patients. He is principal investigator of the four-hospital Utah Critical Care Treatment Group (CCTG), which is a part the ARDS Network for clinical trials of the National Institutes of Health (NIH) and the National Heart, Lung and Blood Institutes (NHLBI). Since 1994 Morris has directed the CCTG, which includes the LDS, intermountain Medical Center, McKay Dee and Utah Valley Regional Medical Center Hospitals.

He is also principal investigator for the NIH-NHLBI Re-engineering Clinical Research in Critical Care contract.

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