This paper is a review of the pros and cons I discovered about clinical decision making software and its involvement, particularly in the ICU. This paper provides answers to how I would approach a prognosis that was determined by the software. Throughout this paper I attempt to weigh the pros and cons of clinical decision making software to traditional treatment minimizing the bias I personally have toward the issue. I didn’t use any direct quotations, the involvement of a reference was to loosely connect my paper to where I retrieved the majority of the information.
Keywords; APACHE, CDSS, objective, EHR
Benefits of CDSS/APACHE Systems
With bulky medical records and limited time spent between patients and their health care providers, it is imperative that a more efficient and reliable method of determining treatment plans is implemented. This is where clinical decision support systems come into play. By using objective data provided by the EHR, the program is able to, without bias, create an evidence based treatment, and in doing so likely decrease the amount of iatrogenic mortalities.
The function of the clinical decision support tool APACHE is to remove the nurse and physician from the difficult decision process involved with ill prognosis that may be difficult to communicate to the families and the client and lessen the margin for error in treating a disease or illness. APACHE is used in intensive care units to determine outcomes and treatment options for individuals. The system condenses the relevant information from a patient’s EHR and predicts the outcome that may be derived from receiving or not receiving treatment. APACHE removes the ability for a bias to be created and may lessen the emotional weight felt by the nurse when she has to deliver the news. APACHE is a dependable predictor because it doesn’t need sleep, a lunch break or a paycheck to do its job. It has the ability to devise a treatment plan regardless the involvement with the client or their family and isn’t phased by the emotions involved with relaying a grim prognosis. APACHE is able to consistently provide information despite the time of day or length of shift.
The Nurse’s Role
As a nurse, relaying important information to the patient, especially detrimental information pertinent to their longevity or lack of, is a moment that should be communicated between humans. Incorporating an inanimate system to do so, depersonalizes the impact and doesn’t seem like it would create a great rapport with the patient or their family. Being able to bridge the gap with compassion, empathy and sincerity is the role of the nurse and would be the deciding factor in whether this product was going to be successful in what it is intended to do. I believe that in order for this program to work its best is to pretend that it doesn’t exist to the patients. By doing so and confronting the patients with information that they perceive is coming from the nurse and physician themselves, seems to be more appropriate and respectful.
Pros
The pros that I discovered when researching CDSS were; reduced medication errors; a reduction in repeated lab testing and unnecessary diagnostic testing. By eliminating excessive testing there is a cost reduction which is also a pro for a hospital. Another pro that I discovered is the lengthened amount of time that a provider has with their patient to discuss their treatment options because they don’t have to seek and gather data and construct a plan, they simply are the medium to initiate the process. Having all of the information at your fingertips also allows a more consistent treatment regimen despite the facility that you may be at and is easily accessed by your provider regardless of their location.
Cons
Important dilemmas that I feel arise from informatic tools such as APACHE are the roles that they play in life or death determination. The first issue that I would have with systems like this would be the inadequacy that I would feel as a healthcare provider. The enormous amount of debt that I would’ve acquired and sleepless nights trying to memorize glycolysis would be seemingly meaningless if told I was being replaced by a much more competent, consistent process that wasn’t a real person. Knowing that a computer can replace and essentially deem incompetent so many would be a catastrophic hit to the swollen egos of healthcare providers everywhere. What is the purpose of a doctor if computers are able to generate better treatment options and can make predictions that doctors are unable to. Why have a doctor if computers can provide this data to any trained body and hurt less people in the process? Software like this also questions if we are becoming too reliant on technology.
The next and last dilemma that I will be discussing is the lack of empathy and relativity that accompanies allowing an algorithm that may or may not take every variable into consideration to be the deciding factor for an individual’s existence. The ethical dilemmas that may ensue by creating care plans from an inanimate object would, in my opinion, leave a wider margin for error and lawsuits. Statistically the program is solid, however, not taking into consideration subjective data about the patient, their religious beliefs and psychological factors substantially diminish the systems capabilities.
I don’t know if the patient is knowledgeable about the involvement of programs like this, but I believe it best to allow, as stated prior, the nurse or physician to pass the information off as a decision made by another human being. Using therapeutic communication and being the messenger to the patient in a manner that is thoughtful as opposed to reading off of a screen and allowing them to believe that no human thought was generated to aid in their future care exhibits the much needed human aspect of healthcare.
As far as being the nurse to have to deliver a poor prognosis that was created by APACHE, I feel like I wouldn’t be able to. God is the ultimate decision maker in my life, I live because he wants me to, I’ll die when I’m supposed to. Who am I to remove a person’s hopes and will to live because I have some presumably accurate data entered by a fallible human being into a program constructed by another human being. I feel that asking a computer to determine life or death is like shaking a magic eight ball only not as much fun.
Conclusion
To conclude, I believe that CDSS is a useful tool that will help decrease the number of accidental deaths related to poor decision making or ineffective treatment programs. I feel that objective data is a great way to predict outcomes but I also believe that the retrieval of that data is equally as important and this is where the program falls short and is unable to self correct. How many errors in charting are transferred from one chart to the next because of shorthanded shifts or sloppy data collection? There are pros and cons to every situation and advancement doesn’t exist without issues. Furthering technology to create better outcomes for patients is always a step in the right direction, however, compassion and understanding need to remain at the forefront of medical treatment. We must remain the bridge between artificial intelligence and the patient. We need to recognize the importance of each other as human beings and how vital we are to one another. We must create and maintain the balance of technology and human involvement.
Reference:
Thompson, R. (2013, July 8) http://www.openclinical.org/dss.html