The Informatics Consult – feasibility to generate new evidence in clinical timescales?
19 April 2021
Clinicians are often faced with a treatment dilemma; they are uncertain whether to give a drug or not. Indeed the majority of treatment recommendations in clinical guidelines are not supported by trial evidence; it is also common for patients to present treatment dilemmas which are not even mentioned in guidelines.
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For example, how does a clinician make a treatment decision for a patient who is suffering from both liver cirrhosis and Atrial Fibrillation, a heart condition which leads to a higher stroke risk for patients? If the patient had only Atrial Fibrillation the treatment would usually be a group of drugs known as anticoagulants, which reduce blood clotting, thus lowering a patient’s risk of stroke. However, patients with cirrhosis are at higher risk of bleeding which anticoagulants can exacerbate. In this example the clinician must select the best treatment – balancing lowering the patient’s stroke risk whilst also manging their liver condition.
To address this problem, a new HDR UK studyis testing the UK’s first prototype of an ‘Informatics Consult’ – a platform that a clinician can use to order the analysis of large-scale health data relevant to an individual patient and their treatment decision, with results returned within minutes or hours. The ‘Informatics Consult’ will allow clinicians to select relevant conditions from a computer interface and order an analysis of raw health data relating to those conditions. The platform will return easily interpretable information to the clinician on outcomes involving patients with the conditions of interest.
Taking a ‘patients like me’ approach the ‘Informatics Consult’ will use population health data contained within EHRs and definitions of disease from the HDR UK Phenotype Library, to improve health care by optimising treatment decisions.
Initially, the platform will be tested with the two conditions in the example above, across four NHS Trusts with the long term ambition to scale up to consider a wide range of multimorbidities where treatment decisions are still not clear. A pilot survey of 34 clinicians revealed that 85% “found information on prognosis useful” and 79% “thought that they should have access to the Informatics Consult as a service within their healthcare systems”.
“Data we gather from the platform could transform health and care. There is so much raw data collected by hospitals, and we want to put this data to use, to shed light on the best treatment approaches where there is uncertainty. This will improve treatment for individual patients, and it will also reveal where we don’t have good evidence for treatment approaches, and indicate what trials we need to do….”