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Can Decision Support Systems Improve Patient Care?
The document discusses clinical decision support (CDS) systems, which enhance healthcare-related decisions with organized clinical knowledge and patient information. It covers types of CDS, including alerts for drug interactions and dose checking, and emphasizes the importance of usability and integration within clinical workflows. Additionally, it highlights that effective CDS can improve patient care quality, safety, documentation, and communication, while also warning against issues like alert fatigue.
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Can Decision Support Systems Improve Patient Care?
- 1. Can decision supportsystems improve patient care? Dr. Alan Brookstone
- 2. 2 Clinical Decision Support •HIMSS Definition – Clinical Decision Support is a process for enhancing health- related decisions and actions with pertinent, organized clinical knowledge and patient information to improve health and healthcare delivery – Made up of: • Clinical elements e.g. reference information • Operational elements e.g. alerts or reminders
- 3. 3 Why Should YouCare About CDS? • You won’t miss stuff • You won’t forget stuff • You can easily find stuff • The stuff is relevant to your patients • The Right information to the Right person at the Right time
- 4. 4 Types of ClinicalDecision Support • General clinical knowledge and guidance • Intelligently processed patient data, or • Mixture of both • Formats include: – Data and order entry facilitators – Filtered data displays – Reference information – Alerts, and – Others e.g. Clinical rules
- 5. Source: HIMSS A simpleand classic CDS example: Drug Interaction Warnings
- 6. Types of CDS •Drug-Drug Interactions • Drug-Allergy interactions • Dose Range Checking • Pick lists • Standardized evidence based order sets e.g. for CDM • Rules (core measures, antibiotic usage, INR management) • Links to knowledge references (in the EMR or Web-based) • Alerts • Templates • Relevant data displays • Point of care reference information • Diagnostic decision support tools
- 7. Additional Perspective onCDS • Active (Driven by an action) – Order sets – Plans of care – Rules and alerts • Passive – Reference information – E.g. Image database for Dermatology (VisualDX) • Must focus on important information without hindering the daily work of the provider • Customizability
- 8. Oder Sets • Allowdoctors to enter one order for a series of actions associated with common conditions and procedures • Work best for small number of regularly seen conditions • Benefits: – Make care more efficient and easy for the majority of patients with frequently occurring conditions – Improve standardization of care – Reminders for safety measures that should be followed • Usually no order sets for rare conditions
- 9. CPOE (Computerized ProviderOrder Entry) • Often hand-in-hand with CDS • Examples: Order investigations (labs, DI) or treatment (meds) • Need to be ‘fine tuned’ or can cause problems – Alert fatigue – overwhelm clinicians with so many alerts that the user ‘tunes out’ the warnings. If do not need actions, cause user fatigue – Also need training to learn how to interpret and use Alerts properly • Archives of Internal Medicine (Sept 14, 2009) – 280,000 electronic alerts communicated to Massachusetts prescribers in 2006 – E-Prescribing alerts in 7.3 percent of the 1.8 million e-prescribing attempts examined – Physicians manually overrode 91.1% of 133,051 alerts – 12,000 alerts that were accepted likely prevented 402 adverse drug events, three deaths, 14 permanent disabilities and 31 cases of temporary disability. – The warnings may also have averted 39 hospital admissions—at an average cost of $9,000 per admission—kept 34 people out of ERs and avoided 267 physician office visits, for an overall savings of $402,619
- 10. 10 Evaluation Criteria forCDS • Relevance • Efficiency • Sensitivity • Currency • Usability
- 11. 11 Relevance • General vs.specialty focused – Alerts, reminders, templates • Is the tool primary care/internal medicine focused? – Chronic disease management • How does it relate to your practice? – EMRs have their strengths and weaknesses
- 12. • Does thetool slow you down or improve efficiency? – Speed of use (number of mouse-clicks) • Does the benefit outweigh the cost in terms of the time it takes to use it? – Financial & time cost vs. clinical benefit 12 Efficiency
- 13. • Does thetool provide the right amount of information to make the decision? – Too much or too little? – Who controls sensitivity settings? • Individual user vs. practice level • Need to ensure the right sensitivity settings – Alert sensitivity too high or low won’t provide the right information at the right time 13 Sensitivity
- 14. • How timelyis the information? Is it up-to-date? – Drug data – Clinical reference data – Out of date information loses relevance 14 Currency
- 15. • How doesthe tool fit into your workflow? – If distracting or poorly designed, can increase risk of error • What is the general satisfaction of users? – Speak with colleagues – Importance of user groups 15 Usability & Human Factors
- 16. Where Can CDSAdd Value? • Improved quality – By guiding users to best practices • Increased safety – By verifying an action was the intended one • Reduced cost – By identifying duplicate or unnecessary orders • Improved documentation – Using templates or order sets for specific conditions • Improved communication – Among clinicians regarding patient status – Between clinicians and patients Source: HIMSS
- 17. What Should DecisionSupport Systems Do? • They need to integrate with your flow • They must be easily understandable • They must be familiar • They must be current • They must not create fatigue
- 18. Features of ClinicalDSS that Succeed • Provided automatically as part of workflow • Support delivered at time and location of decision making • Provide ‘actionable’ recommendations • Computer based BMJ, doi:10.1136/bmj.38398.500764.8F (published 14 March 2005)