The Executive Suite: New clinical guidance tools improving evidence-based care

More and more, clinical guidelines are becoming interwoven within the fabric of a physician’s practice. Everything from point-of-care clinical decisions to hospital/clinic procedures, and even payer reimbursement decisions, are being influenced by guidelines. Although an important player in the evolution of evidence-based care, clinical guidelines can also be overwhelming to physicians.

In 1990, there were only 73 clinical guideline entries in PubMed. Today, only 30 years later, there are thousands of clinical practice guidelines that physicians need to know and thousands more being produced each year. Information overload is a real problem for clinicians in modern medical practice; keeping up-to-date is an added strain on professionals who already feel like they don’t have enough time to manage everything on their plate. More than 70% of physicians meet clinical criteria for burnout, and clinicians are willing to dash out money for solutions that will help them manage their day with less frustration and more efficiency.

“The amount of information that physicians need to keep up with is definitely a contributing factor to burnout,” said Dr. Louis Mullie, chief medical officer, and co-founder at Pathway Medical. “The demands on a practicing physician creates challenges in terms of the time they can allocate to finding the most recent evidence-based recommendation as well as any caveats from more recent literature, for each clinical encounter. It’s just not possible given traditional methodologies.”

To put this into context, It is estimated that medical knowledge now doubles every 73 days. In 1950 the doubling of medical knowledge was 50 years; in 1980, 7 years; and in 2010, 3.5 years, and it is now estimated to be every 0.2 years. Adding to this, the world’s top medical journals in aggregate publish roughly 7,200 articles each month. To evaluate all this information, it would take a physician more than 620 hours per month. Given that one month holds roughly 730 hours, the problem with manual processes becomes apparent.

Dr. Mullie and Pathway Medical are working to lift some of that burden by providing physician-friendly, evidence-based clinical guidance via an easy-to-use mobile app. Pathway’s point-of-care guidance tool provides easier access to important clinical information by using natural language processing and machine learning to streamline and automate manual research and analysis processes. Pathway’s algorithms mine more than 100 million medical research sources, and its system includes more than 1 million structured data points.

Point-of-care clinical reference tools aren’t new. Solutions like UpToDate, BMJ Best Practice, Dynamed and Medscape have been on the market since the early 90’s, and were some of the first to bring the traditional medical textbook to the internet browser. These resources remain some of the most widely consulted by clinicians. However, they have not significantly changed their “textbook in a browser” model since they were introduced 30 years ago. Given the rapid expansion of medical knowledge, more and more physicians now experience these tools as too slow, cumbersome or outdated.

The next generation of point-of-care reference tools is unique in that the tools operate as data companies, while other tools like UpToDate and Medscape operate more as traditional publishers. For example, Pathway’s database understands the links between symptoms, diseases and treatments, given its unique and granular data structure. This “Medical Knowledge Engine”, as the company calls it, is what allows Pathway’s system to display information contextually, and to provide a user experience that is up to par with modern standards.

“Medical guidelines offer clinical guidance, albeit in a way that’s not really adapted to clinical practice,” says Jordan Levy, a general surgery resident from Toronto. “They’re typically PDF documents that aren’t easily searchable, they contain a lot of information that’s not useful at the point-of-care, and it’s hard for a physician to assess their relevance or quality, especially in a clinical context, where time is of the essence. Tools like UpToDate help, but they’re not exactly tailored for quick searches at the bedside.”

AMBOSS is another tool that has been gaining popularity and introducing a more modern approach to decision support. The Berlin-based company started as an educational resource focused on materials specific to the USMLE Step and NBME Shelf exams but has now expanded to cover more bedside decision support content. Over 50 medical schools around the world have adopted it as an essential study resource.

In a company announcement, Benedikt Hochkirchen, co-CEO of AMBOSS stated, “Medical knowledge is exploding and it is almost impossible for doctors to quickly obtain reliable clinical information. Our mission is to connect every doctor with precise medical knowledge to provide the best possible care.”

Kahun is another tool that combines medical knowledge with machine learning algorithms to give guided help with diagnosis, anamnesis, workup planning and access to clinical reasoning.

While these systems can add significant value to the healthcare industry, clinical decision support technologies have also come with substantial challenges. Although they have been around for a number of years, many of them have not been integrated into the clinical point-of-care devices that healthcare professionals are using. Solutions like Pathway and Kahun have answered the challenge, however, by meeting physicians and other healthcare professionals where they are at – on their mobile devices.

Given that medical knowledge is expanding faster than a physician’s ability to assimilate and apply it effectively, the industry’s approach to medical knowledge must fundamentally change. New platforms like Pathway and AMBOSS, which blend gold standard medical knowledge with a modern user interface and advanced technologies, are a leap in the right direction.