Clinical decision-making is based on knowledge, expertise, and authority, with clinicians approving almost every intervention—the starting point for delivery of “All the right care, but only the right care,” an unachieved healthcare quality improvement goal. Unaided clinicians suffer from human cognitive limitations and biases when decisions are based only on their training, expertise, and experience. Electronic health records (EHRs) could improve healthcare with robust decision-support tools that reduce unwarranted variation of clinician decisions and actions. Current EHRs, focused on results review, documentation, and accounting, are awkward, time-consuming, and contribute to clinician stress and burnout. Decision-support tools could reduce clinician burden and enable replicable clinician decisions and actions that personalize patient care. Most current clinical decision-support tools or aids lack detail and neither reduce burden nor enable replicable actions. Clinicians must provide subjective interpretation and missing logic, thus introducing personal biases and mindless, unwarranted, variation from evidence-based practice. Replicability occurs when different clinicians, with the same patient information and context, come to the same decision and action. We propose a feasible subset of therapeutic decision-support tools based on credible clinical outcome evidence: computer protocols leading to replicable clinician actions (eActions). eActions enable different clinicians to make consistent decisions and actions when faced with the same patient input data. eActions embrace good everyday decision-making informed by evidence, experience, EHR data, and individual patient status. eActions can reduce unwarranted variation, increase quality of clinical care and research, reduce EHR noise, and could enable a learning healthcare system.

中文翻译：

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通过自动化计算机协议启用学习医疗保健系统，从而产生可复制和个性化的临床医生操作

临床决策基于知识、专业知识和权威，临床医生几乎批准每一项干预措施——这是提供“所有正确的护理，但只有正确的护理”的起点，这是一个尚未实现的医疗质量改进目标。当独立的临床医生仅根据他们的培训、专业知识和经验做出决策时，他们会遭受人类认知限制和偏见。电子健康记录 (EHR) 可以通过强大的决策支持工具改善医疗保健，减少临床医生决策和行动的不必要变化。目前的电子病历侧重于结果审查、记录和会计，既笨拙又耗时，并且会增加临床医生的压力和倦怠。决策支持工具可以减轻临床医生的负担，并使临床医生能够做出可复制的决策和行动，从而实现个性化患者护理。当前大多数临床决策支持工具或辅助工具缺乏细节，既不能减轻负担，也不能实现可复制的行动。临床医生必须提供主观解释和缺失的逻辑，从而引入个人偏见和盲目的、无根据的、与基于证据的实践的差异。当不同的临床医生在相同的患者信息和背景下做出相同的决定和行动时，就会出现可重复性。我们基于可信的临床结果证据提出了可行的治疗决策支持工具子集：导致可复制的临床医生行动（eActions）的计算机协议。eActions使不同的临床医生在面对相同的患者输入数据时能够做出一致的决策和行动。eActions包括根据证据、经验、EHR 数据和个体患者状态做出良好的日常决策。eActions可以减少不必要的变化，提高临床护理和研究的质量，减少 EHR 噪音，并可以实现学习型医疗保健系统。