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Royal College of Surgeons in IrelandColáiste Ríoga na Máinleá in Éirinn

Computer-Based Clinical Decision Support Systems (CDSSs)

Borislav D Dimitrov

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Contents

1) Clinical & Research Evidence: Implementation in Practice

2) Levels of Functionality in Health Informatics

3) Decision Support Systems (DSSs)

4) Clinical DSSs (computer-based / eCDSSs)

5) CPRs EHR/EPR eCDSSs: Better Decision-Making

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I) Implementation of Evidence

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II) Health Informatics – THE FUTUREEvolution of Functionality

• 1 Record keeping– Medical records– Patient scheduling– Appointments

• 2 Coding & prescribing– Morbidity coding– Drug prescribing– Drug interaction

• 3 Communication– Laboratory– Health professional

& patient

• 4 Clinical knowledge– Clinical DSSs– Decision aids– Comparative

clinical data

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III) DSSs: definition and aspects - 1

Decision Support Systems (DSSs) - a class of computer-based information systems including knowledge-based systems that support decision-making activities:

- parts/blocks: database/KB, model, user interface

- components: inputs, user knowledge/expertise, outputs decisions

- classifications: scope, relationships to user, mode of assistance, evolution, orientation

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III) DSSs: examples - 2

Information Builders' WebFOCUS reporting software (DSS)

Decision Support System (DSS) for John Day Reservoir

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Clinical Decision Support Systems (CDSSs) – a direct aid to clinical decision-making in which the characteristics of an individual patient are matched to a computerized clinical knowledge base, and patient-specific assessments or recommendations are then presented to the clinician and/or the patient for a decision (Sim at al 2001):

- scope: designed ot improve clinical decision-making

- key elements: integration with HER/EPR, computerised-knowledge base, algorithm, patient-specific info

- classifications: context, knowledge & data source, decision support, information delivery, workflow

IV) Clinical DSSs: definition and aspects - 1

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IV) (Computer-based) eCDSS: example - 2

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IV) eCDSS: example - 3 (CPR-based)

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• Increasing Healthcare Quality & Efficiency & Effectiveness

• Helping Clinical Decision-Making Process & Outputs

Translating Knowledge & Novel Evidence into Practice (WP3)

International Register of CPRs eCPRs Integrated eCDSSs

Diagnostic Accuracy () & Medical Errors (): Patient Safety ()

EHR/RCTs Repository of CPRs eCDSSs (TRANSFoRm Project)

V) Computer-Based (e)CDSSs - summary

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Additional-1: Classifications of DSSs (taxonomy)

• Relationships to User: passive, active, cooperative

• Mode of Assistance [driven by]: communication, data, document, knowledge, model

• Scope: enterprise-wide, desktop

• Evolution [support to]: single-user/model-oriented executive ISs, group DSSs, organizational DSSs

• Orientation [frameworks]: text, database, spreadsheet, solver, rule, compound (hybrid)

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• Scope:– Information systems are designed to improve clinical decision

making

• Key elements:– Integration with EPR– Computerized knowledge base– Software algorithm – Provide patient-specific information

Additional-2: Clinical DSSs

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Additional-3: Clinical DSSs classifications (taxonomy)

• Context: setting, task, optimization, point-of-care, barriers to recommended action, external incentives

• Knowledge & Data Source: clinical source, update mechanism, data source, coding, customization

• Decision Support: reasoning method (e.g., CPR), recommendation explicitness, logistical complexity, clinical urgency, response,

• Information Delivery: format, mode, action integration, interactivity, explanations,

• Workflow: data input intermediary, user, DM target, output intermediary, degree of integration