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“We can only see a short distance ahead, but we can see plenty there that needs to be done.”

-Alan Turing

OBJECTIVES

  • Describe the various types of clinical decision support.

  • List various objections to and arguments for the use of clinical decision support (CDS).

  • Describe the importance of building a CDS development team.

  • List the key tasks for CDS deployment.

INTRODUCTION

The U.S. Department of Health and Human Services defines clinical decision support (CDS) as the use of health information technology to provide clinicians and/or patients with clinical knowledge and patient-related information, intelligently filtered or presented at appropriate times, to enhance patient care. Clinical knowledge of interest could include simple facts and relationships, established best practices for managing patients with specific disease states, new medical knowledge from clinical research, and many other types of information.

Although this definition is admittedly rather nonspecific, it makes sense to consider CDS as an array of methods and techniques to provide pertinent, actionable information to the user— in this case a clinician, patient, or other interested stakeholder— at a time when that information might make a difference in the speed, quality and/or delivery of clinical care.

The point of care—that period of time when a clinician is rendering care, writing medical orders, and investigating or documenting symptoms—has typically been considered the moment of maximum return on investment in CDS. There are many other points in the delivery of clinical care that provide opportunities for support as well. CDS can take the form of synchronous alerts or reminders presented to the clinician while ordering (for example, “This patient has a documented allergy to penicillin.”) or be presented in the form of emails or even snail-mail (for example, “Please don't forget your appointment tomorrow.”). CDS systems can monitor physiologic parameters in the ICU and issue providers early warning of deteriorating clinical conditions. Order sets (prewritten groups of orders) can facilitate consistent care processes, and checklists help synchronize care and avoid errors of omission.

The CDS system developed at the Regenstrief Institute in Indianapolis, Indiana, which is computer-based and incorporates the following:

  • Decision support provided automatically as part of provider workflow

  • CDS delivered at the time and location of decision-making

  • Actionable recommendations provided

The CDS system is well accepted by providers and has been documented to improve patient safety and the quality of healthcare delivered (Friedlin, Dexter, & Overhage, 2007; Overhage, Tierney, Zhou, & McDonald, 1997).

Although CDS can be of great help in an environment as complex as healthcare, it carries some risk. Providing meaningful alerts and clinical information poses many challenges in timing, accuracy, currency, and providing information free of bias or commercial intent. When planning any CDS deployment, it is helpful to thoroughly consider the implications of the support not just from clinical and ethical ...

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