Encoding Clinical Pathways: The Impact Beyond the Target

Abstract

The past several years have seen the long-predicted convergence of two trends in modern medicine: the standardization of care and the computerization of the clinical environment. Now, in many care settings, practice improvement has become virtually synonymous with efforts to encode clinical behavior into the electronic health record (EHR) and computerized prescriber order entry (CPOE) systems. Much work on computerized decision support has focused largely on the performance of these systems with respect to the diagnosis or process that they are designed to address, rather than clinical outcomes or local impacts. Clinical tools need to be evaluated from both the perspective of their overall impact on the care environment into which they are being inserted as well as their customizability to best fit the individual patient’s experience of care.