Availability and usage of clinical decision support systems (CDSSs) in office-based primary care settings in the USA

Abstract

BackgroundA clinical decision support system (CDSS) covers a broad spectrum of applications, for example, screening reminders, can reduce malpractice, improve preventive services and enable better management of chronic conditions. CDSSs have traditionally been used successfully in large hospitals. The availability (ie, whether the function is provided by the software) and usage (ie, actual use) of a CDSS in office-based primary care settings, however, are less well studied.ObjectiveTo establish a benchmark of CDSS availability and usage in office-based primary care settings, particularly given the large volume of visits in such settings.MethodsWe used the 2015 Centers for Disease Control and Prevention’s National Ambulatory Medical Care Survey to conduct secondary data analysis. We selected preventive services reminders and drug interaction alerts, along with several other variables as examples of a CDSS.ResultsCDSS usage rates ranged from 68.5% to 100% among solo or non-solo primary care practices owned by physicians or physician groups that have electronic medical records (EMRs)/electronic health records (EHRs) and 44.7% to 96.1%, regardless of EMR/EHR status. According to proportion tests, solo practices had significantly lower CDSS usage and availability rates on several measures if the practice is entirely EMR/EHR based and significantly lower (16.3%–28.9%) CDSS usage rates than did non-solo practices on each measure, regardless of EMR/EHR status.ConclusionIn the USA, a CDSS, especially under the categories of basic preventive reminders and drug interaction alerts, is used routinely between 68% and 100% in primary care if a practice is entirely EMR/EHR based. More work is needed, however, to determine the reasons for large usage gaps between solo and non-solo practices and to reduce such gaps.

Barriers and enablers to implementing and using clinical decision support systems for chronic diseases: a qualitative systematic review and meta-aggregation

“…However, meta-analyses of CDS intervention studies show substantial heterogeneity in effect sizes [ 8 – 10 ]. Furthermore, widespread adoption of CDS systems has not been achieved [ 13 ], and access to CDS does not guarantee user uptake or acceptance in clinical settings [ 14 – 16 ]. For example, a review of 23 studies examining medication CDS systems found that between 46 and 96% of medication alerts were overridden by clinicians [ 15 ].…”

Keyphrase Identification Using Minimal Labeled Data with Hierarchical Contexts and Transfer Learning

“…CDSS has been recognized and adopted broadly in healthcare settings due to its effectiveness in improving healthcare quality, adherence rates in medication prescription, and other clinical orders [13,14]. CDSS is usually a part of an electronic health record system.…”

Uso de la plataforma MAIA® (Medical Artificial Intelligence Aid) para el ajuste de red de servicios durante la pandemia COVID-19 en el departamento de Magdalena, Colombia

“…Se observó una baja utilización del algoritmo de ajuste oferta/demanda, fenómeno que ha sido descrito con una amplia variabilidad de adherencia en otras herramientas de soporte al razonamiento clínico y que requieren un proceso de alfabetización digital para los equipos decisores 8 .…”