AI is Bringing a Popular Clinical Decision Support Tool to EHRs—With 'Virtually Zero' Risk

One of doctors' favorite tools is coming to their fingertips, thanks to artificial intelligence.

Wolters Kluwer Health is integrating its popular clinical decision support solution, UpToDate, into doctors' workflows through Wellsheet—a company offering "smart" AI-powered user interfaces that aim to simplify electronic health records (EHRs).

Concord Hospital Health System in New Hampshire will be first to pilot the new capabilities. The three-hospital system is a longtime user of both UpToDate and Wellsheet, and its clinicians "depend [on the tools] every day," according to its chief quality officer Dr. Christopher Fore.

"I'm pretty sure this is going to be a hit based on people's respect for and ability to use this tool," Fore told Newsweek on September 20.

UpToDate has more than 3 million users worldwide and is among the most-used knowledge resources for health care professionals, according to Dr. Peter Bonis, chief medical officer at Wolters Kluwer Health and a gastroenterologist and adjunct professor at Tufts University School of Medicine. In a July 31 call with Newsweek, he said UpToDate has "earned the trust of health care professionals" over its 30-year life cycle—but he thinks newer technologies like AI can "help us to do even better."

Currently, doctors access UpToDate in a web-based browser and can search the application's database for the most recent clinical evidence. Unlike Google, UpToDate is designed specifically for clinicians. Its editorial staff performs comprehensive reviews of all medical literature before making it searchable, so doctors can trust the information without having to quality-check for themselves. Physicians who want to dive deeper can click directly into the reference material and read more.

When UptoDate is combined with Wellsheet—which is currently integrated with the EHRs Oracle Cerner, Epic and athenahealth and has more than 30,000 clinician users—it could be even easier for doctors to find trustworthy information.

The first phase of Concord's pilot will integrate UpToDate's lab and clinical calculator interpretations directly into Wellsheet, which is embedded in the system's EHR, Oracle Cerner. When physicians are looking through patient data, they will be offered direct links to applicable applications. For example, if a patient has an abnormal level in their labs, Wellsheet will provide a link to better understand that value via UpToDate's literature. Where a chart indicates potential risk of stroke or cardiovascular events, doctors will be offered a link to UpToDate's disease risk calculator.

Wellsheet has already made information in the EHR more "clearly visible, digestible, usable and convenient," Fore said. This has helped the health system address issues with length of stay and capacity. He believes that tying in UpToDate's content will yield even better outcomes.

"The entire tool is really designed to make your work easier, to make your day more efficient and to present data in a way that people would desire to see it," Fore said. "Adding evidence-based reference content seems like a tremendous opportunity."

But there are right and wrong ways to implement new technologies, Bonis said. If done incorrectly, prompts could be a distraction or nuisance to doctors. That's why he also focuses on the non-AI details of UpToDate—from its structure to the words and graphics it uses.

"All of those things come into play to make sure that you have a very seamless and reliable interaction between someone wanting information and then delivering not only what they thought they wanted, but actually what they needed," Bonis said. "Part of our efforts around AI are to find thoughtful ways to deliver clinicians information that don't interrupt them while they're working."

That's why Wellsheet aims to present UpToDate's information "contextually," according to Craig Limoli, Wellsheet's founder and CEO.

"While UpToDate has a really incredible and deep level of content across a really wide variety of subjects, Wellsheet will surface only what matters most to the physician," Limoli told Newsweek on September 20.

Both companies hope their collaboration could help reduce doctors' cognitive burden by streamlining access to the information they need most. The health care industry generates approximately 30 percent of the world's data volume, and that number is expected to grow to 36 percent by 2025. That's a lot of content for busy doctors to sift through, and the resulting overwhelm is a documented cause of burnout.

Health tech companies are racing to create large language models that could aid clinical decision support, but studies suggest that they aren't ready for prime time. Many existing AI tools are prone to hallucinations, leaving doctors rightfully skeptical.

But with UpToDate, "the hallucination risk is practically eliminated because you have all of the reference information there in front of you," Limoli said. "We have access to the full patient chart in Wellsheet that the physician can review and trustworthy content from UpToDate, so that we're using AI in a way that really empowers clinicians to make better decisions, rather than taking them out of the loop."

Fore agreed that UpToDate specifically has been "really warmly received by providers" and that in this application, the risk of hallucination is "virtually zero."

Limoli eventually aims to bring the application to health systems nationwide, starting with those that are already customers of both UpToDate and Wellsheet. It's an easy-to-implement and "highly scalable" solution, he said.

As for Fore, he's excited about AI's potential to decrease doctors' guesswork—beyond the tools that already exist.

"What primary care doctor wouldn't want to turn to a screen and say, 'Make me a list of every patient that didn't refill their prescriptions last month?'" Fore said. "I think that's the brave new future. It's going to take us a while to get there."