Background: Today, clinicians are required to take into consideration increasing quantities of clinical data for each patient and ever expanding, rapidly changing bodies of evidence-based research. This is particularly challenging in rural and remote Australia where patients are more at risk from chronic disease-associated complications and there is a greater reliance on locum and short-term health professionals.
Clinical Decision Support Systems have been praised for their potential to increase the quality and efficiency of the management of often-complex patient conditions. The building blocks for timely, effective decision support systems are already in place: comprehensive Electronic Health Record systems and relevant, current standards of treatment.
Methods: The TEAMSnet Electronic Decision Support (EDS) application for clinicians has been developed to provide diabetes and CVD management recommendations based on both the Central Australian Rural Practitioners Association (CARPA Standard Treatment Manual (vol. 5, no. 6) and clinical information stored in a patient’s Electronic Health Record (Communicare). Where assessment required information that was not available in the patient’s records, the necessary collection tools were developed and/or deployed. These include surveys to capture S.N.A.P.E (Smoking Nutrition Alcohol Physical Activity and Emotional Wellbeing) benchmarks. Three Aboriginal community controlled health organisations from across the Northern Territory participated (600 patients). A working group made up of research clinicians and a senior site-clinician tested the application and provided feedback that resulted in a substantial re-writing of the decision support algorithms. The EDS application was implemented at the Central Australian Aboriginal Congress in Alice Springs where EDS recommendations for 300 study participants are being evaluated.
Results and conclusions: Both the development process and clinician feedback have already provided valuable insights to inform the future direction of EDS development and implementation. While the promise of potential benefits is great, there are clear lessons for future deployments of EDS and other e-health strategies in this challenging environment. We need to address the challenges and opportunities at each level of patient care. By communicating feedback from patients, health workers and physicians on EDS treatment recommendations to the standards committees and the research community, we can drive continuous improvement.