BMJ Best Practice – access to decision support, the digital agenda, and health literacy
Professor Sheona Macleod, Interim Medical Director, Health Education England
Dr Kieran Walsh, Clinical Director, BMJ
BMJ Best Practice is the clinical decision support tool of the BMJ. It offers continually updated, evidence-based and practical content that helps doctors and other healthcare professionals make better clinical decisions.
This is the second of a series of blogs on clinical decision support, healthcare professional education, and BMJ Best Practice by Sheona Macleod and Kieran Walsh. This second blog concentrates on the latest thinking on equity of access to decision support, the digital agenda, and improving patient health literacy.
BMJ Best Practice is freely available to all healthcare professionals who work for the NHS in England as a result of a national subscription from Health Education England. The purpose of this provision is to ensure that continually updated and evidence-based medical knowledge is constantly in the hands of healthcare staff.
Equity of access and availability of clinical decision support and BMJ Best Practice is vital.
Health Education England are providing a national subscription to this resource to give uniform and universal access across the whole NHS workforce. This is important for healthcare professionals and patients because there are differences in standards of care across the country and one of the ways of reducing inequity is to make sure that everyone has access to expert knowledge. So if you're in a large centre, you have access to knowledge but also access to learning about how experts think. Gaining an understanding of the decision-making processes behind clinical decisions are part of what junior doctors and other professionals value in education and training. We want healthcare professionals in all settings - from community settings to district hospitals - to have the same access to learning to understand the decision-making process. Providing online clinical decision support through BMJ Best Practice enables healthcare professionals to understand and follow the processes behind decisions and ensure that there is equity of access to educational thinking and analysis. Patients can be assured that the healthcare professional seeing them in whatever setting is as updated in their knowledge and has as much exposure to critical thinking as they would in any other setting. In the past, this was partly dependent on the placement, available consultants and different standards of care. Universal access to point of care clinical decision support will enable everyone to have access to knowledge and promote consistently high standards. This kind of innovation will do more for helping with inequalities in healthcare than many other bigger and more expensive projects.
Another important theme in clinical decision support is the digital agenda.
At the very least this emphasises the importance of mobile resources, offline apps, and integration with electronic health records. The digital agenda is something that is obviously racing ahead and in medicine we're trying to keep up. We have been slower to adapt than certain sectors, but we are starting to catch up. The ideal has to be that digital care enabled us to be more patient-focused. This means care that is based on an individual’s exact condition. So the importance of being able to integrate diagnostic and management tools with individual information is going to be key. Health Education England wants a digitally informed workforce where healthcare professionals use all the benefits available in the digital age. But before we get there, we need to work on the basics also. From what we found when developing systems, we know that there have been times when healthcare professionals on a ward round have had to log into lots of different systems. This slows things down and interrupts the clinical workflow. What healthcare professionals need is quick and seamless access to knowledge and data. This means integration into electronic health records – so that the evidence is one click away at all times. This is doubly the case in busy clinical environments. Healthcare professionals just don’t have time to go elsewhere to look things up. Eventually, when knowledge is integrated, healthcare professionals will have the patient’s individual results alongside the knowledge that underlies clinical decision support. This will mean more personalised care because healthcare professionals will be able to look at the patient’s condition and instantly access information.
Yet another theme which overlaps with the strategy of clinical decision support and BMJ Best Practice is that of public and patient health literacy.
BMJ Best Practice contains over 400 patient information leaflets on the most common and important conditions. These are written in patient-friendly laypersons’ language, aimed at a reading age of 12, and they are all short – three or four pages long on what a patient’s disease might mean and what tests they might need to have and what treatments they might be offered. When patients are in contact with healthcare professionals, they are anxious and so they don't necessarily process things in the same way as they would in a normal conversation. So having information to back up what the healthcare professional is saying is essential. This is invaluable in all settings. Of course now with Covid-19 there are going to be fewer consultations where there are relatives to support a patient. So in these new circumstances, patient leaflets will be even more useful. The ultimate purpose is to drive shared decision making, better patient choice and better patient experience.
In recent years, BMJ has also produced an increasing number of infographics to show diagnostic and treatment guidelines in new ways that will appeal to a variety of different types of learner. Such infographics and flowcharts can also be shown to patients. This helps patients see how and why decisions must be made – so that they can also understand healthcare professional thinking and contribute to shared decision making. This makes it easier for patients to have informed input into their care and truly feel that they are partners in making a decision and that healthcare professionals are not making incorrect assumptions about what matters to them. Thus the patient information leaflets and infographics on BMJ Best Practice should make a real difference in explaining clinicians’ thinking to patents and so lead to better shared decisions. The result should be higher quality and more patient centred care.
Funded by Health Education England, BMJ Best Practice is free to all NHS staff.
KW works for BMJ which produces BMJ Best Practice.