Abstract
Clinical decision support systems (CDSS) are computer systems designed to impact clinician decision making about individual patients at the point in time that these decisions are made.With the increased focus on the prevention of medical errors that has occurred since the publication of the landmark Institute of Medicine report, To Err Is Human, computer-based physician order entry (CPOE) systems, coupled with CDSS, have been proposed as a key element of systems’ approaches to improving patient safety.1–4 If used properly, CDSS have the potential to change the way medicine has been taught and practiced. This chapter will provide an overview of clinical decision support systems, summarize current data on the use and impact of clinical decision support systems in practice, and will provide guidelines for users to consider as these systems begin to be incorporated in commercial systems, and implemented outside the research and development settings. The other chapters in this book will explore these issues in more depth.
This chapter is an updated version of Chapter 36 in Ball MJ, Weaver C, Kiel J (eds). Healthcare Information Management Systems, Third Edition, New York: Springer-Verlag, 463-477, used with permission.
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References
Kohn LT, Corrigan JM, Donaldson MS, eds. To err is human: building a safer health system. Washington, DC: National Academy Press; 2000.
Institute of Medicine. Crossing the quality chasm: a new health system for the 21st century. Washington, DC: National Academy Press; 2001.
The Leapfrog Group. www.leapfroggroup.org
Bates DW, Leape LL, Cullen DJ, et al. Effect of computerized physician order entry and a team intervention on prevention of serious medical errors. JAMA 1998;280:1311–1316.
Oliveira, J. A shotgun wedding: business decision support meets clinical decision support. J Healthc Inf Manage 2002;16:28–33.
DeGruy KB. Healthcare applications of knowledge discovery in databases. J. Healthc Inf Manage 2000;14:59–69.
Perreault LE, Metzger JB. A pragmatic framework for understanding clinical decision support. In: Middleton, B, ed. Clinical Decision Support Systems. J Healthc Inf Manage 1999;13:5–21.
Metzger J, MacDonald K. Clinical decision support for the independent physician practice. Oakland: California Healthcare Foundation; 2002.
Shortliffe EH, Axline SG, Buchanan BG, Merigan TC, Cohen SN. An artificial intelligence program to advise physicians regarding antimicrobial therapy. Comput Biomed Res 1973;6(6):544–560.
Miller RA, Pople HE Jr., Myers JD. Internist-I, an experimental computer-based diagnostic consultant for general internal medicine. N Engl J Med 1982; 307:468–476.
Miller RA, McNeil MA, Challinor S, Masarie FE Jr, Myers JD. Internist-I, quick medical reference project-status report. West J Med 1986;145:816–822.
Miller RA, Masarie FE Jr. The demise of the “Greek Oracle” model for medical diagnostic systems. Methods Inf Med 1990;29:1–2.
Tan JKH, Sheps S. Health decision support systems. Gaithersburg: Aspen Publishers, Inc.; 1998.
Kuperman GJ, Teich JM, Bates DW, et al. Detecting alerts, notifying the physician, and offering action items: a comprehensive alerting system. Proc AMIA Annu Fall Symp 1996:704–708.
Shabot MM, LoBue M, Chen J. Wireless clinical alerts for physiologic, laboratory and medication data. Proc AMIA Symp 2000:789–793.
Geissbuhler A, Miller RA. Clinical application of the UMLS in a computerized order entry and decision-support system. Proc AMIA Symp 1998:320–324.
Galanter WL, DiDomenico RJ, Polikaitis A. Preventing exacerbation of an ADE with automated decision support. J Healthc Inf Manage 2002;16(4):44–49.
Eccles M, McColl E, Steen N, et al. Effect of computerised evidence based guidelines on management of asthma and angina in adults in primary care: cluster randomised controlled trial. BMJ 2002;325:941.
Marakas GM. Decision support systems in the 21st century. Upper Saddle River: Prentice Hall; 1999.
Devillers J, ed. Neural networks in QSAR and drug design. London: Academic Press; 1996.
Hirshberg A, Adar R. Artificial neural networks in medicine. Isr J Med Sci 1997;33:700–702.
Cross S, Harrison R, Kennedy RL. Introduction to neural networks. Lancet 1995;346:1075–1079.
Baxt WG. Application of artificial neural networks to clinical medicine. Lancet 1995;346:1135–1138.
Holst H, Astrom K, Jarund A, et al. Automated interpretation of ventilation-perfusion lung scintigrams for the diagnosis of pulmonary embolism using artificial neural networks. Eur J Nucl Med 2000;27:400–406.
Olsson SE, Ohlsson M, Ohlin H, Edenbrandt L. Neural networks—a diagnostic tool in acute myocardial infarction with concomitant left bundle branch block. Clin Physiol Funct Imaging 2002;22:295–299.
Naguib RNG, Sherbet GV, eds. Artificial neural networks in cancer diagnosis, prognosis, and patient management. Boca Raton: CRC Press; 2001.
Levin M. Use of genetic algorithms to solve biomedical problems. MD Comput 1995;12:193–199.
Laurikkala J, Juhola M, Lammi S, Viikki K. Comparison of genetic algorithms and other classifications methods in the diagnosis of female urinary incontinence. Methods Inf Med 1999;38:125–131.
Doolan DF, Bates DW, James BC. The use of computers for clinical care: a case series of advanced U.S. sites. J Am Med Inform Assoc 2003;10:94–107.
Berner ES, Houston TK, Ray MN, et al. Improving ambulatory prescribing safety with a handheld decision support system: a randomized controlled trial. J Am Med Inform Assoc 2006;13:171–179.
Thomas NJ. ISABEL. Crit Care 2002;7:99–100.
Ramnarayan P, Tomlinson A, Rao A, Coren M, Winrow A, Britto J. ISABEL: a web-based differential diagnostic aid for paediatrics: results from an initial performance evaluation. Arch Dis Child 2003;88:408–413.
Ramnarayan P, Kapoor RR, Coren M, et al. Measuring the impact of diagnostic decision support on the quality of decision-making: development of a reliable and valid composite score. J Am Med Inform Assoc 2003;10:563–572.
Berner ES, Maisiak RS, Cobbs CG, Taunton OD. Effects of a decision support system on physicians’ diagnostic performance. J Am Med Inform Assoc 1999;6: 420–427.
Berner ES, Maisiak RS. Influence of case and physician characteristics on perceptions of decision support systems. J Am Med Inform Assoc 1999;6:428–434.
Friedman CP, Elstein AS, Wolf FM, et al. Enhancement of clinicians’ diagnostic reasoning by computer-based consultation. A multisite study of 2 systems. JAMA 1999;282:1851–1856.
Evans RS, Pestotnik SL, Classen DC, et al. A computer-assisted management program for antibiotics and other antiinfective agents. N Engl J Med 1998;338: 232–238.
Doolan DF, Bates DW. Computerized physician order entry systems in hospitals: mandates and incentives. Health Aff 2002;21:180–188.
Kucher N, Koo S, Quiroz R, et al. Electronic alerts to prevent venous thromboembolism among hospitalized patients. N Engl J Med 2005;352:969–977.
Wong HJ, Legnini MW, Whitmore HH. The diffusion of decision support systems in healthcare: are we there yet? J Healthc Manage 2000;45:240–249; discussion 249-253.
Garg AX, Adhikari NK, McDonald H, et al. Effects of computerized clinical decision support systems on practitioner performance and patient outcomes: a systematic review. JAMA 2005;293:1223–1238.
Kaplan B. Evaluating informatics applications—clinical decision support systems literature review. Int J Med Inform 2001;64:15–37.
de Dombal FT. The diagnosis of acute abdominal pain with computer assistance: worldwide perspective. Ann Chir 1991;45:273–277.
Adams ID, Chan M, Clifford PC, et al. Computer aided diagnosis of acute abdominal pain: a multicentre study. BMJ 1986;293:800–804.
Burt CW, Hing E. Use of computerized clinical support systems in medical settings. United States, 2001–2003. Advance data from vital and health statistics; no. 353. Hyattsville, MD: National Center for Health Statistics; 2005.
KLAS Research and Consulting Firm. CPOE digest (computerized physician order entry). KLAS Enterprises, LLC; 2003.
Keefe B, Subramanian U, Tierney WM, et al. Provider response to computer-based care suggestions for chronic heart failure. Med Care 2005;43:461–465.
Covell DG, Uman GC, Manning PR. Information needs in office practice: Are they being met? Ann Intern Med 1985;103:596–569.
Gorman PN, Helfand M. Information seeking in primary care: How physicians choose which clinical questions to pursue and which to leave unanswered. Med Decis Making 1995;15:113–119.
Berner ES, Maisiak RS, Phelan ST, Kennedy JI, Heudebert GR, Young KR. Use of a diagnostic decision support system by internal medicine residents. Unpublished study; 2002.
Teich JM, Merchia PR, Schmiz JL, Kuperman GJ, Spurr CD, Bates DW. Effects of computerized physician order entry on prescribing practices. Arch Intern Med. 2000;160:2741–2747.
Bria WF. Clinical decision support and the parable of the stick shaker. J Healthc Info Manage 2005;19:8–9.
Kawamoto K, Houlihan CA, Bala EA, Lobach DF. Improving clinical practice using clinical decision support systems: a systematic review of trials to identify features critical to success. BMJ 2005;330:765.
Turisco F, Case J. Wireless and mobile computing. Oakland, CA: California Healthcare Foundation; 2001.
Morris AH. Decision support and safety of clinical environments. Qual Saf Health Care 2002;11:69–75.
Weed LL, Weed L. Opening the black box of clinical judgment—an overview. BMJ 1999;319:1279. Data Supplement-Complete Version. Available from: http://www.bmj.org/cgi/content/full/319/7220/1279/DC1.
Osler, Harkins, Harcourt Law Firm. Ten commandments of computerization. Reprinted with permission by the Canadian Information Processing Society; 1992. Available from: http://www.cips.ca/it/resources/default.asp?loadpractices.
Terry NP. When the machine that goes “ping” causes harm: default torts rules and technologically-mediated health care injuries. St Louis Univ Law J 2002; 45:37–59.
Osheroff JA, Pifer EA, Sittig DF, Jenders RA, Teich JM. Clinical decision support implementers’ workbook. Chicago, HIMSS, 2004. Available from: www.himss.org/cdsworkbook. Second edition: Improving outcomes with clinical decision support: an implementers’ guide; HIMSS, 2005.
Brannigan VM, Dayhoff RE. Medical informatics. The revolution in law, technology and medicine. J Leg Med 1986;7:1–53.
Sim I, Gorman P, Greenes RA, Haynes RB, Kaplan B, Lehmann H, Tang PC. Clinical decision support for the practice of evidence-based medicine. J Am Med Inform Assoc 2001;8:527–534.
Kittelson B. Spotlight: CPR systems. Healthc Inform 2002;18:41–47.
Marietti C. The 2002 Healthcare Informatics 100. Healthc Inform 2002;18:33–64.
Poikonen J. Arden syntax: the emerging standard language for representing medical knowledge in computer systems. Am J Health Syst Pharm 1997;54: 281–284.
Hsieh TC, Kuperman GJ, Jaggi T, et al. Characteristics and consequences of drug allergy alert overrides in a computerized physician order entry system. J Am Med Inform Assoc 2004;11:482–491.
Berner ES, Maisiak RS, Heudebert GR, Young KR Jr. Clinician performance and prominence of diagnoses displayed by a clinical diagnostic decision support system. AMIA Annual Symp. Proc 2003:76–80.
Friedman CP, Gatti GG, Franz TM, et al. Do physicians know when their diagnoses are correct? Implications for decision support and error reduction. J Gen Intern Med 2005;20:334–339.
Miller RA, Schaffner KF, Meisel A. Ethical and legal issues related to the use of computer programs in clinical medicine. Ann Intern Med 1985;102:529–536.
Fried BM, Zuckerman JM. FDA regulation of medical software. J Health Law 2000;33:129–140.
Miller RA, Gardner RM. Recommendations for responsible monitoring and regulation of clinical software systems. J Am Med Inform Assoc 1997;4: 442–457.
Osheroff JA, Teich JM, Middleton BF, Steen EB, Wright A, Detmer DE. A roadmap for national action on clinical decision support. For AMIA as a work product for ONC contract HHSP23300500877P. June 13, 2006. Available from: http://www.amia.org/inside/initiatives/cds/cdsroadmap.pdf. Accessed on July 8, 2006.
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Berner, E.S., La Lande, T.J. (2007). Overview of Clinical Decision Support Systems. In: Berner, E.S. (eds) Clinical Decision Support Systems. Health Informatics. Springer, New York, NY. https://doi.org/10.1007/978-0-387-38319-4_1
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