Dr Robert Dubois Outlines Barriers to Adoption of Clinical Pathways

Pathways are still a young enterprise so barriers to their adoption are being more readily recognized than the number of problems being solved are, according to Robert Dubois, MD, PhD, chief science officer and executive vice president of the National Pharmaceutical Council.

Transcript (slightly modified for readability)

What barriers are preventing wider adoption of pathways and how can they be overcome?

There are a number of barriers that we observed to wider adoption of pathways. One of the most important is physician uncertainty. Physicians don't like the concept of cookbook medicine: first you do this, then you do this, then you do something else. Now in many cases that may be the optimal way to help the patient, but if the physician feels there are extenuating circumstances, unique characteristics of that patient, then they want to feel that there is flexibility.

And the good news is that for many of the groups that are monitoring and rewarding physicians for compliance, they're not asking for 100% compliance. Actually the number that we often see is 85%, so that 15% of the patients, for reasons that are clinically very important, different approaches might be necessary.

On the IT front. that's a whole other barrier, which is you see your patient, what are the pathways, what are the things I need to consider. And having electronic health records that would then bring up the pathway and make certain that the elements of the pathway would be reimbursed by the insurance company—there is a lot of barriers related to that.

Pathways are a young enterprise and so the barriers are being more quickly identified than the problems solved.