Two recent research briefs demonstrate how challenging is the task of getting physicians to be appropriate stewards of antibiotics and have implications for CDS. Antibiotics were one of the miracles of 20th century medicine, leading to substantial ability to fight infection. They are still an important armamentarium of medicine, but their value is threatened by growing resistance of organisms .
One research brief finds that the likelihood of antibiotic prescribing becomes higher as day goes on, which the researchers call "decision fatigue" . Another brief shows that implementation of a physician audit and feedback program resulted in reducing inappropriate antibiotic prescribing, but that removal of the program resulted in a return toward baseline prescribing habits . This finding has been found in other similar programs .
Practicing medicine is a complex task. Although physicians have always been assumed to maintain the entire knowledge base in their heads, decades of informatics-related research has shown otherwise. Of course, the way we implement CDS is imperfect, often providing advice that physicians do not need . A big challenge going forward will be to optimize the signal vs. noise and determine the best ways to deliver that signal.
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