Computer-Based Clinical Decision Support System

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Incorporating Evidence:

Use of Computer-Based

Clinical Decision Support Systems

for Health

Professionals

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OBJECTIVES:

1.Define computerized clinical decision support systems (CDSS)

2. Identify types of CDSS, their characteristics, and the levels of responsibility implicit in the use of each type

3.Describe effects of CDSS on clinician performance and patient outcomes in healthcare

4.Understand the features, benefits and limits of CDSS

5.Develop a future vision for CDSS within nursing.

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Decision Support System (DSS)

-are automated tools designed to support decision-making activities and improve the decision-making process and decision outcomes

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Clinical Decision Support System (CDSS)

-Designed to support healthcare providers in making decisions about the delivery and management of patient care -Goals may include: patient safety & improved outcomes for specific patient populations as well as compliance with clinical guidelines, standards of practice and regulatory requirements

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Clinical Tasks of CDSS:

Alerts and remindersDiagnostic assistanceTherapy critiques and

plansMedication ordersImage recognition and

interpretationInformation retrieval

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Clinical Decision Support System (CDSS)

Any computer program that helps health professionals make clinical decisions

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Clinical Decision Support System (CDSS)

Are software designed to be a direct aid to clinical decision-making, in which the characteristics of an individual patient are matched to a computerized clinical knowledge base and patient specific assessment/recommendations are then presented to the clinician or the patient for a decision

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Main Purpose of DSS are to:

Assist in problem solving with semi structured problems

Support, not replace, the judgment of a manager or clinician

Improve the effectiveness of the decision-making process

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Types & characteristics:

Administrative & Organizational

Systems

Integrated Systems

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Included in the field of healthcare decision support are systems

that: Support organizationalExecutive/managerialFinancialClinical decisions

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Administrative System:

Designed for finance/quality monitoring- support the business decision-making processSystem encompass decision processes other than direct patient care delivery

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Administrative System:

Clinical in nature- such as quality improvement systems– mainly used for strategic planning, budgeting, financial analysis, quality management, continuous process improvement and clinical benchmarking

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Integrated Systems…Able to support outcomes performance management by integrating

Operational data (the business side)– budgeting, executive decision-making, financial analysis, quality management & strategic planning data

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Integrated Systems…Clinical data (the clinical side)- clinical event tracking, results reporting, pharmaceutical ordering & dispensing, differential diagnoses, real-time clinical pathways, literature research and clinical alerts

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Key CDSS Functions:Administrative- support for clinical coding and documentation

Management of clinical complexity and details- keeping patients on research and chemotherapy protocols, tracking orders, referrals, follow-up, and preventive care

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Key CDSS Functions:

Cost control- monitoring medication orders and avoiding duplicate or unnecessary tests

Decision support- supporting clinical diagnostic and treatment plan processes promotion of best practices, use of condition-specific guidelines, and population-based management

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Key CDSS Function Stan & Sheps, 1998 according to :

Data-based systems-Capitalize on the fundamental input into any intelligent system

-They provide decision support with a population perspective

Model-based DSSKnowledge-based systemsGraphics-based systems

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Model- based DSS-Driven by access to and manipulation of a statistical, financial, optimization and/or simulation model-Data are compared to various decision-making and analytic models

Knowledge-based systems (Evidence-Based Practice)-rely on expert knowledge that is either embedded in the system or accessible from another source and uses some type of knowledge acquisition process to understand and capture the cognitive process of healthcare providers

Graphics-based systems-take advantage of the user interface to support decisions by providing decision “cues” to the use in the form of color, graphical representation options and data visualization

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Examples of CDSS Applications1.Reminders and alerts which are computer tools for focusing attention such as “flags” for abnormal values

2.Therapy critiquing and planning as well as care maps, guidelines, protocols and so on

3.Diagnostic assistance providing patient-specific consultations using diagnostic or management tools, such as Problem Knowledge Couplers

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Examples of CDSS Applications4. Lab systems with interpretation

of measured values and automated preparation of reports as well as physician guidance as to which tests to order

5. Prescribing decision support such as drug advisory systems used for advising on drug-drug interactions, side effects, selecting most cost-effective drug

6. Clinical workstations with online literature, e-tools for calculation, patient guidelines

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7. Image recognition and interpretation with capabilities of mass screening -e.g. mammography, assistance with expensive and complex investigations- e.g MRI

8. Signal interpretation such as interpretive alarms for real-time clinical signals in intensive care unit (ICU), automated electrocardiogram (ECG) interpretation, retinal scans and voice recognition

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9. Natural language/speech recognition which offers interpretation of freely entered clinical notes and archiving to make electronically accessible in the future

10.Evidence-based quality improvement using up-to-date and consistent tools

11.Multitask tools for assessment, diagnosis and management

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Barriers to the Use of CDSS Systems

Lack of noticeable benefitsInsufficient cost benefitsInadequate staff trainingLack of system supportSystem costLack of exposure to technologyUsers reluctance to use automated decision support

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Implications for Future Uses of CDSS in NursingIncreasing Inclusion of Patients

-allow patients or their representatives access their own

medical records-allow patient access to the knowledge base of the system

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Implications for Future Uses of CDSS in NursingDual Purpose Documentation

-first: improving care for the individual patient-second: improving care for future populations of patients via aggregated information used for clinical decision-making

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CDSSCan improve patient care qualityReduce medication errorsMinimize variances in careImprove guideline compliancePromote cost savings