Clinical Decision Support Systems

Clinical Decision Support Systems

Health informatics refers to the implementation of information technology in order to evaluate health records so as to enhance healthcare records. It mainly majors in resources, appliances and the techniques to implement storage, retrieval, and use in health and medicine. Healthcare informatics gives electronic access to medical records to patients, insurance firms, and healthcare professionals. The Clinical Decision Support System (CDSS) is one of the technologies used in health informatics. These are the systems that are developed so as to enhance decision-making based on the diagnostic or therapeutic procedures of care. They use certain parameters such as diagnoses, laboratory results, medication options, and complex integration of clinical data in order to offer certain patient encounters during care. In this essay, we shall identify the goals, effectiveness, and healthcare settings of the Clinical Decision Support Systems.

Based on HealthITAnalytics (2017), the main goals of the CDSS are to reduce clinical variation and duplicative testing, enhance patient safety, and prevent issues that lead to costly hospital readmissions. It also aims at interpreting the electrocardiogram, predicting the risk of death from the severity of sickness, diagnosing the illness, assisting in identifying the medication for the illness, and lastly, suggesting other medications.

CDSS is designed in order to aid in examining large amounts of digital data in order to identify the next step for treatment, notify the physicians about the accessible data that they might not have noticed, or identify potential issues such as fatal medication interactions. CDSS gives physicians and patients information that is filtered or aimed at a certain individual. It is meant to enhance care quality as one avoids common mistakes and to enable care team members to be more effective. CDSS may involve a wide range of decision-making assistance, for instance, computerized notifications and reminders to cater to caregivers and patients, hospital-based instructions, patient-based date reports and summaries, and efficient reference information on other tools.

The implementation of CDSS has made great positive changes to the healthcare facility. It has aided in reducing medical errors. Basically, the health facilities were under great pressure to address the medical errors that were becoming too many. They are expected to find ways to prevent the errors by making them undetectable and reducing their impacts. Several researchers have affirmed that CDSS can be effective in minimizing medication errors by enabling physicians to avoid fatal drug impacts, minimize inappropriate drug dosing, and increase the use of efficient prophylactic techniques. Based on Jao and Hier (2010), CDSS is effective in minimizing medical errors, and they argued that the enhancement and automation of CDSS assist physicians by making the errors easily seen, thus making it easy to prevent the errors. It achieves this by involving notifications, reminders, advice, critiques, and suggestions for enhanced care. Through this, CDSS acquires the ability to minimize error rates by affecting the physician’s behavior.

Similarly, CDSS has aided in enhancing the diagnostic and workflow procedures in healthcare. Several researchers agreed that CDSS has the ability to minimize medical diagnostic errors and improve the quality of care. It efficiently assists the health care providers in meeting the need for chronic care. The system has the ability to achieve this by evaluating the patient’s features to offer filtered advice for diagnostics. The CDSS has the ability to enhance the physician’s workflow by providing a satisfactory system performance, which leads to appropriate system dependence (Casimir, 2015).

CDSS has been effectively implemented to aid in the advancement of several clinical practices. According to Pearson and his associates (2009), currently, healthcare facilities use the CDSS in disease management to aid in managing several illnesses and improve the quality of care. CDSS can also be effective in developing a disease management plan after a specific illness has been identified. CDSS can also enhance chronic disease management techniques and, in other instances, patient results. To achieve this, the systems have to be used in the health facilitates so as to assist the clinician in making decisions that positively affect the results of care.

Similar to the clinical improvements attributed to the use of CDSS, it also enables a major reduction in the cost of care. CDSS can reduce the expense of care by informing the physician of likely duplicative testing. Based on the Agency of Healthcare Research and Quality (2009), CDSS can be effective in minimizing the expenses of care that mostly originate from Adverse Drug Events. Therefore, according to the report, the CDSS can result to expense minimization in the clinical practice. Since the ADEs maximize the costs and CDSS has the ability to identify and possibly avoid ADEs, it is taken that the CDSS can minimize the health care costs by assisting in minimizing the ADEs.

In addition, CDSS has aided in the development of personalized medicines that implement patient’s genes, proteins, and biomarkers to identify medication and diagnosis based on that patient. Personalized medicine is a type of medicine that implements details on an individual’s genes, protein, and environment to avoid, diagnose, and manage an illness.

Personalized medicines are composed of multidisciplinary connections of human and medical genetics, pharmaceutics, biomaterial banking, medical study, and patient data management. Therefore, the CDSS for personalized medicine is required to integrate techniques acquired from the bioinformatics domain with knowledge and experience (Denecke & Spreckelsen, 2013).

However, the CDSS has its own comebacks. Fragmented workflows are one of the limitations of the CDSS. CDSS, at times, interferes with clinical workflow, mostly in the case of stand-alone systems. CDSS can also interfere with the workflows if it is developed without human information processing and behaviors in consideration. Altering with workflows can maximize the cognitive effort; long durations are needed to finish the task and limited duration with face-to-face with patients. In addition, it also involves ineffective alerts. Its alerts are at times, inconsequential, and most health professionals do not agree with the distrust alerts. At other times, they do not even read them. One may as well suffer from alert fatigue due to inessential alerts. Disruptive alerts should only be meant for life-threatening conditions rather than general conditions.

CDSS can also affect the users’ skills. CDSS develops the perspective that confirming the accuracy of an order is ineffective. It is essential to identify the likely long-term impact of a CDSS on users. It can develop a training impact in a way that the CDSS will not be required. Health caregivers tend to develop excessive dependence on CDSS for certain activities (Goddard et al., 2011). This is fatal since the user has little independence and maybe limitedly equipped for the activity if they are taken to a context that does not have the CDSS.

Successful clinical decision support systems in health facilities should involve clinical decision support systems in the available systems. Successful CDSS are those that are integrated into an available EGR and computerized physician order entry systems. It has the benefit of making use of the accessible data within the system to efficiently produce responses. A firm should make sure that the CDSS can be used together with the available systems prior to deciding on the CDSS product. One always ensures that the CDSS is compatible with the systems that are there in the firm to avoid unintended failures during implementation.

The clinical decision support systems are developed to serve a specific issue and offer a wide spectrum of several techniques that are expected to be used in the right way. The rules that aren’t specific efficiently and more detailed can lead to the provision of unnecessary alerts, thus leading to the user becoming desensitized. Desensitized users lead to overriding or canceling alerts. The CDSSs that have the guidelines are very specific and may not sufficiently produce sufficient alerts for the approach that requires attention. Clinical decision support system user involvement in the planning development. Design and use of the CDSS is advantageous to the last acceptance and effective use of the CDSS. Maximized involvement offers the users a feeling of ownership of CDSS. Engagement between the users and the developers of the system is required so as to obtain optimal CDSS results in the specified area.

Successful clinical decision support system in education and training. Users that are effectively trained in the implementation of the system. Containing a clear understanding of the way the CDSS functions maximizes the user’s ownership of the system, which motivates the user to feel more engaged in the use of the CDSS and also be more accepting. In comparison, the individuals who are not sufficiently skilled in the use of the CDSS have the potential to portray resistance and disprove the CDSS being used. Users should acquire comprehensive training based on the CDSS so as to have a concise understanding of the system (Courtney, Alexander & Demiris, 2008).

In conclusion, CDSS is a combined element of attaining the appropriate use criteria so as to enhance the standard of patient care. Several factors are expected to be put into perspective when making use of the CDSS. Without sufficient preparation and planning, a CDSS can be insufficient to fulfill its purpose. It is essential to consider that for one to have an efficient CDSS, the system should be integrated into the existing workflow and the existing health information systems. It involves the end users in all stages during the implementation, offers enough training, education, and support, and ensures that notifications are simple and specialized to the areas that are major and require quick attention.

References

Agency of Healthcare Research and Quality (2009). Clinical decision support systems: State of the Art

Casimir, P. (2015). Role of clinical decision support systems in improving clinical practice. MOJ Clinical & Medical Case Reports, 2(6):146-151. DOI: 10.15406/mojcr.2015.02.00045

Courtney, K. L., Alexander G. L. & Demiris G. (2008). Information technology from novice to expert: implementation implications. J Nurs Manage. 16, pp. 692-699

Denecke K, & Spreckelsen C. (2013) Personalized medicine and the need for decision support systems. Stud Health Technol Inform. 186 p. 41–45.

Goddard, K., Roudsari, A., &Wyatt, J. (2011). Automation bias – A hidden issue for clinical decision support system use. Stud. Health Technol. Inform. 164, 17–22

HealthITAnalytics. (2017, December 12). Understanding the Basics of Clinical Decision Support Systems. Retrieved from https://healthitanalytics.com/features/understanding-the-basics- of-clinical-decision-support-systems

Jao, S. C. & Hier, D. B. (2010). Clinical Decision Support Systems: An Effective Pathway to Reduce Medical Errors and Improve Patient Safety. DOI:10.5772/39469

Pearson SA, Moxey A, Robertson J, et al. (2009). Do computerized clinical decision support systems for prescribing change practice? A systematic review of the literature (1990- 2007). BMC Health Serv Res.9 (154).

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Week 5

Clinical Decision Support Systems

Preparing the Assignment

Post a written response in the discussion forum to EACH threaded discussion topic:

This week, we learned about the potential benefits and drawbacks of clinical decision support systems (CDSSs). Create a “Pros” versus “Cons” table with a column for “Pro” and a separate column for “Con”. Include at least three items for each column. Next to each item, provide a brief rationale as to why you included it on the respective list.

Clinical Decision Support Systems

The primary goal of a CDSS is to leverage data and scientific evidence to help guide appropriate decision-making. CDSSs directly assist the clinician in making decisions about specific patients. For this discussion thread post, you are to assume your future role as an APN and create a clinical patient scenario to illustrate an exemplary depiction of how a CDSS might influence your decision. This post is an opportunity for you to be innovative, so have fun!

Adhere to the following  guidelines regarding quality for the threaded discussions in Canvas:

Application of Course Knowledge: Demonstrate the ability to analyze, synthesize, and/or apply principles and concepts learned in the course lesson and outside readings.

Scholarliness and Scholarly Sources: Demonstrates achievement of scholarly inquiry for professional and academic decisions using valid, relevant, and reliable outside scholarly sources to contribute to the discussion thread.

Writing Mechanics: Grammar, spelling, syntax, and punctuation are accurate. In-text and reference citations should be formatted using the correct APA guidelines.

Direct Quotes: Good writing calls for the limited use of direct quotes. Direct quotes in discussions are to be limited to one short quotation (not to exceed 15 words). The quote must be added substantively to the discussion. Points will be deducted under the grammar, syntax, and APA categories.

For each threaded discussion per week, the student will select no less than  TWO scholarly sources to support the initial discussion post.

Scholarly Sources: Only scholarly sources are acceptable for citation and reference in this course. These include peer-reviewed publications, government reports, or sources written by a professional or scholar in the field. The textbooks and lessons are  NOT considered to be outside scholarly sources. For the threaded discussions and reflection posts, reputable internet sources such as websites by government agencies (URL ends in .gov) and respected organizations (often ends in .org) can be counted as scholarly sources. The best outside scholarly source to use is a peer-reviewed nursing journal.  You are encouraged to use the Chamberlain Library and search one of the available databases for a peer-reviewed journal article.  The following sources should not be used: Wikipedia, Wikis, or blogs.  These websites are not considered scholarly, as anyone can add to these. Please be aware that .com websites can vary in scholarship and quality.  For example, the American Heart Association is a .com site with scholarship and quality.  It is the responsibility of the student to determine the scholarship and quality of any .com site.  Ask your instructor before using any site if you are unsure. Points will be deducted from the rubric if the site does not demonstrate scholarship or quality. Current outside scholarly sources must be published within the last 5 years.  Instructor permission must be obtained BEFORE the assignment is due if using a source that is older than 5 years.