The impact and use of clinical decision support tools

carmen raal e-estonia

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Healthcare systems across the globe are under tremendous pressure. Lack of resources, funding, and professionals was painstakingly evident even before the pandemic, further increasing waiting times and general access to healthcare services. The National Institute for Health Development reports that although life expectancy for people in Estonia will increase, their years lived healthily are not going through the same upward trend. Additionally, every third person in Estonia already feels constraints due to their health, and the health gap between different regions in Estonia is becoming more and more evident.

Inadequate human resources are not new in Estonia and are only limited to the healthcare sector. Although, it is one of the most, if not the most, painful areas for our nation to need more professionals. After all, health affects all the other sectors of our life, and the well-being of Estonians also influences the state’s budget. Above all, everyone deserves timely and good quality healthcare for a fulfilled life. Since health is so valuable, it is essential to spend doctors’ time wisely; being chronically understaffed, every second counts.

And this is where technology comes to play. To ensure doctors get to be doctors and save their time being detectives combing through years and years of health data, different lab results, and prescriptions, in 2020, the clinical decision support tool was introduced in Estonia. The tool does the aforementioned detective work instead of analysing all the data and giving recommendations to the doctors promptly.

The Health and Welfare Information Systems Centre has summed up the three goals of the decision tool:

  • Prevention – it is essential to know the genetic peculiarities of the patient and to notice and analyse early symptoms. PS! The prevention aspect is a work in progress.
  • Diagnosing illnesses – health care decision support is used to determine the correct diagnosis.
  • Treatment stage – decision support is significant in choosing suitable procedures, medicines, and doses for the person in question.

Additionally, clinical decision support is the first case for the secondary use of health data in Estonia. This is possible because, in 2008, it became mandatory for doctors to digitise health data and gradually, structured data in healthcare that enables it all has also become a priority. Is it a new solution on the shelf, or do doctors see the actual value in the tool?

Many people familiar with the field of digital transformation know the issue of onboarding end users to novel solutions; you might hear them saying how time and patience are of the essence. So, how time-consuming and exhausting has it been to onboard doctors and nurses? Luckily, in this case, doctors have largely embraced their new digital colleagues. A year ago, the Estonian Health Insurance Fund gathered feedback from family nurses and physicians across Estonia to discover how well-accepted the clinical support tool is in their daily work.

79% of respondents use the clinical tool in their daily work. For most users, the support tool has had a real effect by making them reconsider the treatment plan, planned tests, and diagnoses or has nudged the family physicians and nurses to consult other specialists.

But there is room for improvement since almost half of the non-users felt that they did not need the support tool in their daily work; others thought it was not user-friendly. Using a new tool almost always requires time to get familiar with – read guidelines or attend trainings. For people working in healthcare, this borders on the line of luxury.


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