Royal College of Surgeons in Ireland Col

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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
Decision Support System (DSS) for John Day
Reservoir
Information Builders' WebFOCUS reporting
software (DSS)
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IV) Clinical DSSs definition and aspects - 1

• 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

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IV) (Computer-based) eCDSS example - 2
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IV) eCDSS example - 3 (CPR-based)
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V) Computer-Based (e)CDSSs - summary

• 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)

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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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Additional-2 Clinical DSSs

• Scope
• Information systems are designed to improve
  clinical decision making
• Key elements
• Integration with EPR
• Computerized knowledge base
• Software algorithm
• Provide patient-specific information

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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