Abstract
Clinical decision support (CDS) systems provide clinicians and patients with intelligently filtered information at appropriate times to foster better health processes, better individual patient care, and better population health. This chapter provides a brief history of CDS systems, reviews best practices for implementing CDS, describes the knowledge management cycle, and highlights unintended consequences of CDS coupled with quality, safety, ethical, legal, and regulatory concerns. Emerging trends include the use of CDS to enable population health management and to conduct clinical trials.
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References
Osheroff JA, Teich JM, Middleton B, Steen EB, Wright A, Detmer DE. A roadmap for national action on clinical decision support. J Am Med Inform Assoc. 2007;14(2):141–5.
Johnston ME, Langton KB, Haynes RB, Mathieu A. Effects of computer-based clinical decision support systems on clinician performance and patient outcome. A critical appraisal of research. Ann Intern Med. 1994;120(2):135–42.
Hunt DL, Haynes RB, Hanna SE, Smith K. Effects of computer-based clinical decision support systems on physician performance and patient outcomes: a systematic review. JAMA. 1998;280(15):1339–46.
Balas EA, Weingarten S, Garb CT, Blumenthal D, Boren SA, Brown GD. Improving preventive care by prompting physicians. Arch Intern Med. 2000;160(3):301–8.
Garg AX, Adhikari NKJ, McDonald H, Rosas-Arellano MP, Devereaux PJ, Beyene J, et al. Effects of computerized clinical decision support systems on practitioner performance and patient outcomes: a systematic review. JAMA. 2005;293(10):1223–38.
Wright A, Sittig DF. A four-phase model of the evolution of clinical decision support architectures. Int J Med Inform. 2008;77(10):641–9.
De Dombal FT, Horrocks JC, Staniland JR, Guillou PJ. Construction and uses of a “data-base” of clinical information concerning 600 patients with acute abdominal pain. Proc R Soc Med. 1971;64(9):978.
De Dombal FT, Leaper DJ, Staniland JR, McCann AP, Horrocks JC. Computer-aided diagnosis of acute abdominal pain. Br Med J. 1972;2(5804):9–13.
De Dombal FT, Leaper DJ, Horrocks JC, Staniland JR, McCann AP. Human and computer-aided diagnosis of abdominal pain: further report with emphasis on performance of clinicians. Br Med J. 1974;1(5904):376–80.
Miller RA, Pople HE, Myers JD. Internist-1, an experimental computer-based diagnostic consultant for general internal medicine. N Engl J Med. 1982;307(8):468–76.
Miller RA, McNeil MA, Challinor SM, Masarie FE, Myers JD. The INTERNIST-1/QUICK MEDICAL REFERENCE project – status report. West J Med. 1986;145(6):816–22.
Barnett GO, Cimino JJ, Hupp JA, Hoffer EP. DXplain. An evolving diagnostic decision-support system. JAMA. 1987;258(1):67–74.
DXplain FAQ [Internet]. [Cited 10 Jan 2015]. Available from: http://dxplain.org/dxplain_faq.html.
Bond WF, Schwartz LM, Weaver KR, Levick D, Giuliano M, Graber ML. Differential diagnosis generators: an evaluation of currently available computer programs. J Gen Intern Med. 2012;27(2):213–9.
Kuperman GJ, et al. HELP: a dynamic hospital information system. New York: Springer; 1991.
Gardner RM, Pryor TA, Warner HR. The HELP hospital information system: update 1998. Int J Med Inform. 1999;54(3):169–82.
Sittig DF, Gardner RM, Pace NL, Morris AH, Beck E. Computerized management of patient care in a complex, controlled clinical trial in the intensive care unit. Comput Methods Programs Biomed. 1989;30(2–3):77–84.
Gardner RM, Golubjatnikov OK, Laub RM, Jacobson JT, Evans RS. Computer-critiqued blood ordering using the HELP system. Comput Biomed Res. 1990;23(6):514–28.
Lepage EF, Gardner RM, Laub RM, Golubjatnikov OK. Improving blood transfusion practice: role of a computerized hospital information system. Transfusion. 1992;32(3):253–9.
Evans RS, Pestotnik SL, Classen DC, Clemmer TP, Weaver LK, Orme JF, et al. A computer-assisted management program for antibiotics and other antiinfective agents. N Engl J Med. 1998;338(4):232–8.
Austin SM, Balas EA, Mitchell JA, Ewigman BG. Effect of physician reminders on preventive care: meta-analysis of randomized clinical trials. Proc Annu Symp Comput Appl Med Care. 1994;121–4.
Schedlbauer A, Prasad V, Mulvaney C, Phansalkar S, Stanton W, Bates DW, et al. What evidence supports the use of computerized alerts and prompts to improve clinicians’ prescribing behavior? J Am Med Inform Assoc. 2009;16(4):531–8.
Schnipper JL, Linder JA, Palchuk MB, Einbinder JS, Li Q, Postilnik A, et al. “Smart Forms” in an Electronic Medical Record: documentation-based clinical decision support to improve disease management. J Am Med Inform Assoc. 2008;15(4):513–23.
Henry SB, Douglas K, Galzagorry G, Lahey A, Holzemer WL. A template-based approach to support utilization of clinical practice guidelines within an electronic health record. J Am Med Inform Assoc. 1998;5(3):237–44.
The five rights of clinical decision support: CDS tools helpful for meeting meaningful use [Internet]. [Cited 12 Jan 2015]. Available from: http://library.ahima.org/xpedio/groups/public/documents/ahima/bok1_050385.hcsp?dDocName=bok1_050385.
Bates DW, Kuperman GJ, Wang S, Gandhi T, Kittler A, Volk L, et al. Ten commandments for effective clinical decision support: making the practice of evidence-based medicine a reality. J Am Med Inform Assoc. 2003;10(6):523–30.
Wright A, Sittig DF, Ash JS, Sharma S, Pang JE, Middleton B. Clinical decision support capabilities of commercially-available clinical information systems. J Am Med Inform Assoc. 2009;16(5):637–44.
Field MJ, Lohr KN, editors. Guidelines for clinical practice: from development to use. Washington: National Academy Press; 1992.
Centers for disease control Ebola algorithm [Internet]. [Cited 12 Jan 2015]. Available from: http://www.cdc.gov/vhf/ebola/pdf/ebola-algorithm.pdf.
Hripcsak G, Ludemann P, Pryor TA, Wigertz OB, Clayton PD. Rationale for the arden syntax. Comput Biomed Res. 1994;27(4):291–324.
Parker CG, Rocha RA, Campbell JR, Tu SW, Huff SM. Detailed clinical models for sharable, executable guidelines. Stud Health Technol Inform. 2004;107(Pt 1):145–8.
Ram P, Berg D, Tu S, Mansfield G, Ye Q, Abarbanel R, et al. Executing clinical practice guidelines using the SAGE execution engine. Stud Health Technol Inform. 2004;107(Pt 1):251–5.
Johnson PD, Tu SW, Musen MA, Purves I. A virtual medical record for guideline-based decision support. Proc AMIA Symp. 2001;294–8.
Kawamoto K, Lobach DF. Design, implementation, use, and preliminary evaluation of SEBASTIAN, a standards-based Web service for clinical decision support. AMIA Annu Symp Proc. 2005;380–4.
Standards & Interoperability (S&I) framework – health eDecisions homepage [Internet]. [Cited 12 Apr 2015]. Available from: http://wiki.siframework.org/Health+eDecisions+Homepage.
OpenCDS home [Internet]. [Cited 12 Apr 2015]. Available from: http://www.opencds.org/.
Goldberg HS, Paterno MD, Rocha BH, Schaeffer M, Wright A, Erickson JL, et al. A highly scalable, interoperable clinical decision support service. J Am Med Inform Assoc. The Oxford University Press; 2014;21(e1):e55–62.
Sittig DF, Wright A, Simonaitis L, Carpenter JD, Allen GO, Doebbeling BN, et al. The state of the art in clinical knowledge management: an inventory of tools and techniques. Int J Med Inform. NIH Public Access;2010;79(1):44–57.
Sittig DF, Wright A, Meltzer S, Simonaitis L, Evans RS, Nichol WP, et al. Comparison of clinical knowledge management capabilities of commercially-available and leading internally-developed electronic health records. BMC Med Inform Decis Mak. 2011;11(1):13.
Kesselheim AS, Cresswell K, Phansalkar S, Bates DW, Sheikh A. Clinical decision support systems could be modified to reduce “alert fatigue” while still minimizing the risk of litigation. Health Aff (Millwood). 2011;30(12):2310–7.
Ash JS, Sittig DF, Campbell EM, Guappone KP, Dykstra RH. Some unintended consequences of clinical decision support systems. AMIA Annu Symp Proc. 2007;26–30.
Lo HG, Matheny ME, Seger DL, Bates DW, Gandhi TK. Impact of non-interruptive medication laboratory monitoring alerts in ambulatory care. J Am Med Inform Assoc. 2009;16(1):66–71.
Phansalkar S, van der Sijs H, Tucker AD, Desai AA, Bell DS, Teich JM, et al. Drug-drug interactions that should be non-interruptive in order to reduce alert fatigue in electronic health records. J Am Med Inform Assoc. 2013;20(3):489–93.
Biondich PG, Dixon BE, Duke J, Mamlin B, Grannis S, Takesue BY, et al. Regenstrief medical informatics: experiences with clinical decision support systems. In: Greenes RA, editor. Clinical decision support: the road to broad adoption. 2nd ed. Burlington: Elsevier, Inc.; 2014. p. 165–87.
D’Avolio L, Ferguson R, Goryachev S, Woods P, Sabin T, O’Neil J, et al. Implementation of the Department of Veterans Affairs’ first point-of-care clinical trial. J Am Med Inform Assoc. 2012;19(e1):e170–6.
Embi PJ, Jain A, Harris CM. Physicians’ perceptions of an electronic health record-based clinical trial alert approach to subject recruitment: a survey. BMC Med Inform Decis Mak. 2008;8(1):13.
Learning health community [Internet]. [Cited 10 Feb 2015]. Available from: http://www.learninghealth.org/.
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Singh, K., Wright, A. (2016). Clinical Decision Support. In: Finnell, J., Dixon, B. (eds) Clinical Informatics Study Guide. Springer, Cham. https://doi.org/10.1007/978-3-319-22753-5_6
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DOI: https://doi.org/10.1007/978-3-319-22753-5_6
Publisher Name: Springer, Cham
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