Clinical cognitive/decision support using a CHARTSaaS RA-compatible IT solution

“It’s ironic that just when clinicians feel that there’s no time in their daily routines for thinking, the need for deep thinking is more urgent than ever. Medical knowledge is expanding rapidly, with a widening array of therapies and diagnostics fueled by advances in immunology, genetics, and systems biology. Patients are older, with more coexisting illnesses and more medications. They see more specialists and undergo more diagnostic testing, which leads to exponential accumulation of electronic health record (EHR) data. Every patient is now a ‘big data’ challenge, with vast amounts of information on past trajectories and current states.

All this information strains our collective ability to think. Medical decision making has become maddeningly complex. Patients and clinicians want simple answers, but we know little about whom to refer for BRCA testing or whom to treat with PCSK9 inhibitors. Common processes that were once straightforward — ruling out pulmonary embolism or managing new atrial fibrillation — now require numerous decisions.

So, it’s not surprising that we get many of these decisions wrong. Most tests come back negative, yet misdiagnosis remains common.1 Patients seeking emergency care are often admitted to the hospital unnecessarily, yet many also die suddenly soon after being sent home.2 Overall, we provide far less benefit to our patients than we hope. These failures contribute to deep dissatisfaction and burnout among doctors and threaten the health care system’s financial sustainability.

If a root cause of our challenges is complexity, the solutions are unlikely to be simple. Asking doctors to work harder or get smarter won’t help. Calls to reduce ‘unnecessary’ care fall flat: we all know how difficult it’s become to identify what care is necessary. Changing incentives is an appealing lever for policymakers, but that alone will not make decisions any easier: we can reward physicians for delivering less care, but the end result may simply be less care, not better care.

The first step toward a solution is acknowledging the profound mismatch between the human mind’s abilities and medicine’s complexity. Long ago, we realized that our inborn sensorium was inadequate for scrutinizing the body’s inner workings — hence, we developed microscopes, stethoscopes, electrocardiograms, and radiographs. Will our inborn cognition alone solve the mysteries of health and disease in a new century? The state of our health care system offers little reason for optimism.

But there is hope. The same computers that today torment us with never-ending checkboxes and forms will tomorrow be able to process and synthesize medical data in ways we could never do ourselves. Already, there are indications that data science can help us with critical problems.”

The preceding excerpt from the article entitled Lost in Thought — The Limits of the Human Mind and the Future of Medicine by Ziad Obermeyer, M.D., and Thomas H. Lee, M.D, in the September 28, 2017, edition of The New England Journal of Medicine ( demonstrates the growing need for real-time information technology (IT) support for clinical cognition and decision support. Applications for mobile devices a.k.a. apps, created with an IT solution compliant with the Cloud Healthcare Appliance Real-Time Solution as a Service reference architecture (CHARTSaaS RA), fulfill the identified need, not only by providing IT-enabled cognitive support but also by providing a means for healthcare provider subject matter experts (SMEs) with the tools and methods to create apps without excessive cost (no capital costs required) or IT complexity (little/no impact on provider IT system or staff resources).

Please validate the foregoing CHARTSaaS RA-related propositions to your own satisfaction by reading the white paper at, viewing the tutorials posted on YouTube ( and and also by reviewing the details of CHARTSaaS™ and the CHARTSaaS RA™ in these presentations:

Healthcare providers will benefit significantly from appreciating and then applying a CHARTSaaS RA-compliant IT solution. To do so will mitigate medical mistakes (currently the third leading cause of patient deaths. per Makaray and Daniel (; thereby minimizing patient adverse events and optimizing clinical case outcomes while maximizing the cost-effectiveness of care and treatment, and also accelerating the accrual and facilitating the application of medical knowledge.

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