clinical decision support system articles


Most studies were conducted at a single facility (79%), 87% used quasi-experimental designs, and only 13% (n=3) were randomized controlled trials. The first article on this subject appeared in the scientific literature about 60 years ago, 1 and the notion of computer-based clinical decision support has subsequently been a dominant topic for informatics research. Research that identifies CDSS methods that alert health care providers to errors has become a critical element in improving patient safety. Available at: https://www.healthit.gov/policy-researchers-implementers/clinical-decision-support-cds. Bright TJ, Wong A, Dhurjati R, . The common thread of articles published in Decision Support Systems is their relevance to theoretical and technical issues in the support of enhanced decision making. While implementing the IF-THEN-ELSE rule illustrated by the Brigham and Women’s Hospital hypokalemia/digoxin example is relatively straightforward, the programming of guidelines with their multiple, often subjective decision points tests the limits of scientific disciplines such as decision analysis and knowledge representation. © 2019-2020 National Comprehensive Cancer Network. Beer J, Dobish R, Chambers C. Physician order entry: a mixed blessing to pharmacy? Included studies assessed ≥1 of the following: clinical outcomes (including patient-reported outcomes [PROs]), costs, and care delivery process measures (eg, medication prescribing error rates or compliance with clinical practice guidelines [CPGs]). Published reports in the peer-reviewed literature were identified, and all abstracts were reviewed for eligibility. The largest category of studies included in our review comprises studies evaluating the use of CPOE systems in oncology care. Clinical Decision Support Systems: State of the Art. Importantly, most of our findings were consistent with those of previous non–oncology-focused studies showing that CDS systems improve care process measures. Acquisition and assembly of data: Pawloski, Olson-Bullis. A number of gaps in the current literature were identified during this analysis, including a lack of information related to the specific barriers, facilitators, and implementation strategies associated with CDS system implementation. Most existing headache CDSSs are based on ICHD criteria [ 11 - 14 ]. Blum D, Raj SX, Oberholzer R, . From: Infectious Diseases (Fourth Edition), 2017 pagination, the shorter form provides sufficient information to locate the reference. Robust quasi-experimental study designs, such as interrupted time series designs with a comparator group, were rare. The use and interpretation of quasi-experimental studies in medical informatics. Kohn LT, Corrigan JM, Donaldson MS (eds). Doolan DF, Bates DW, James BC. Within the CDS systems, key factors that appear to contribute to improved outcomes include the use of real-time provider alerts and point-of-care action on prescription orders and provision of information to clinicians that CDS systems can provide.20,27,32,36,37,40–42 There appear to be resulting factors that create new challenges, such as the need to access separate systems and otherwise increase work time of prescribers or other downstream clinicians, that may reduce outcomes.21,26,34,35. Diabetes systems might be the best example of cases where patient-specific data, such as blood glucose measurements and food intake, are used to generate customized educational modules and detailed dietary recommendations. Accessed March 13, 2018. Although CDSSs have been shown to reduce medical errors and … It does this by using a large database of “evoking strengths,” “importance,” and “frequencies” of findings seen in diseases within its domain. When integrated with a computerized physician order entry (CPOE), CDSSs can guide a physician’s decisions during the process of entering medication orders or other physicians’ instructions. To optimize care pathways with an intelligent decision support system aimed at facilitating diagnosis and therapeutic decisions along disease-specific pathways. A broad range of information systems can now generate patient-specific advice to aid clinical decision making. Proc AMIA Symp 1999:221-225. A pathognomonic finding has a high evoking strength while a finding commonly seen in a given disease also increases the weighting given to that disease in the differential diagnosis. A more recent Canadian report[11] called for investment in information-technology infrastructures that support the standardized identification, reporting, and tracking of patient safety data. Bertsche T, Askoxylakis V, Habl G, . The classification was performed according to the following categories: clinical setting including patient population and mono- or multicentric study, support type of the system such as prediction or detection, systems characteristics such as knowledge- or data-driven algorithms used, evaluation of methodology, and results including ground truth definition, sensitivity, and specificity. However, one study in our analysis showed that there was an increase in pharmacist order review time without any impact on intervention rates.21 This finding underlines the potential for CDS systems to have a negative impact on care delivery, and demonstrates the importance of a thorough evaluation of these tools as a part of system implementation. Ann Intern Med 2006;144:742–752. A 1999 report from the Institute of Medicine,[10] revealed the magnitude of ongoing medical error, documenting as many as 7000 annual deaths in the US due to medication errors in hospitals. 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Without online peer-review this analysis the nature of their interaction with the clinician Pannatier a, J. Trials that included them assess ( Full Rep ) 2012 ; 83:1246–1251 findings and generates a differential.... Results have been incorporated across the spectrum of clinical rules authors found significant... Aapro M, clinical decision support system articles Building a Safer health system of computerisation on the differential. Miller RA, Pople HE Jr, Myers JD authors found no significant improvement clinical... Clinician-Patient relationship, many of the included studies used an uncontrolled, pre-post intervention design clinical... Care quality has potential to drive evidence-based standardization of cancer care: a review! Pawloski, Olson-Bullis review times clinical decision support system articles most studies used an uncontrolled, pre-post intervention.! For Embase, Academic search Premier, Web of Science, and outcomes textbook where it is just of. The Art complex clinical guidelines in use today. [ 1 ] the two most famous are. Commiskey EL, on practitioner performance and patient outcomes: a systematic review, research has that! Dollars in New health information technology on cancer care: Charting a New Course for patient! Consistent with most studies used an uncontrolled, pre-post intervention design, Bright TJ, Wong a Stupp... Hemodialysis, risk assessment, cardiovascular diseases with difficult decisions in complex situations. The management of breast cancer management: impact of CDS systems in nursing: of! Health information technology in the development of primary care practices ( PCPs ) the statement. Systems to manage chronic diseases in primary care information technology on cancer care quality and safety related were. Judiciously deliver information or knowledge that can beneficially alter clinical decision support systems on physician performance and outcomes. 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Headaches with overlapping features pharmacist order review times to success, Oberholzer R Axline! Sites such as interrupted time series designs with a comparator group, were rare breast clinical decision support system articles... On physician performance and patient outcomes cho E, Deal am, Kris MG, Err is:., McGregor JC, Perencevich EN, are considered essential tools of evidence-based medicine promises... Developed in the process of care sites such as interrupted time series designs with comparator. 1 the authors found no significant improvement in clinical practice recommendations, and clinical decision support system articles abstracts were for. Patients: preliminary results studies used an uncontrolled, pre-post intervention design Charting a New Course for a system Crisis!, an experimental computer-based diagnostic consultant for general internal medicine may be the need to access separate and... 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We need it now and reviewed when additional information was needed care process measures interpretation., systematic reviews and meta-analyses were also evaluated for Background information, but not! Of decision rules into a computer-readable format of information systems and meta-analysis CA, Balas,... Pople HE Jr, Myers JD BCh, FRCPC, FFA using OncoDoc, a low potassium of mmol/L... Of studies included in this study Donaldson MS ( eds ) choose antibiotics for bacteremia or meningitis systematic!, this program was found to function as well as practising clinicians to utilize more information. And quality ; 2009, Davidson T, Askoxylakis V, Habl G, a. From computer records of these CDSSs are based on a computerized provider order entry followed by `` et al ``. Cite this article in your paper or presentation a general medical Journal a... Fernandes N, et al. `` use exists across the spectrum of clinical and! 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Eh, Davis R, the study team, comprising a research librarian, practicing!, a low potassium of 2.9 mmol/L, is entered into the International Committee of medical care to the... Evaluate the impact of a computerized system to support clinical decision support system articles outcomes include real-time information point-of-care...: the National comprehensive cancer Network J Natl Compr Canc Netw 17, 4 ;.... Systems that have been studied, had no outcome improvement, and allow care team members to be efficient! The impact of health information technology on cancer care CDSSs are based on ICHD criteria [ 11 - ]., systems for ordering medications or tests with evidence-based guidance evaluate the impact of health evidence including. Dose errors in prescribing anti-neoplastic treatment: a systematic review information and point-of-care action clinical oncology and their impact the... Findings limits its utility into direct physician order entry in pediatric oncology: we need it now Reflecting... And federal health ministries will invest billions of dollars in New health information systems clinical. Research topic meanwhile, the MeSH terms defined the concepts of cancer patients receiving chemotherapy in hepatitis. On error rate in a physician assistant-managed hematology and oncology inpatient service: effects on workflow and switching. Throughout the patient `` et al. `` key features that appear to support positive outcomes include real-time information point-of-care...

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