Clinical Decision Support Systems: Impacting the Future of Clinical Decision Making

Berner, Eta S.; Lande, Tonya La

doi:10.1007/978-1-4757-4041-7_36

Cited by 46 publications

(56 citation statements)

References 31 publications

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“…CCDSSs for drug therapy management are used to facilitate evidence-informed medication use [4], reduce the incidence of harmful medication errors [5], and improve healthcare system efficiency [2,4,6]. In this review, we considered any CCDSS that provides recommendations to healthcare providers regarding the initiation, modification, monitoring, or discontinuation of drug therapy, based on the patient's characteristics.…”

Section: Introductionmentioning

confidence: 99%

Computerized clinical decision support systems for drug prescribing and management: A decision-maker-researcher partnership systematic review

et al. 2011

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BackgroundComputerized clinical decision support systems (CCDSSs) for drug therapy management are designed to promote safe and effective medication use. Evidence documenting the effectiveness of CCDSSs for improving drug therapy is necessary for informed adoption decisions. The objective of this review was to systematically review randomized controlled trials assessing the effects of CCDSSs for drug therapy management on process of care and patient outcomes. We also sought to identify system and study characteristics that predicted benefit.MethodsWe conducted a decision-maker-researcher partnership systematic review. We updated our earlier reviews (1998, 2005) by searching MEDLINE, EMBASE, EBM Reviews, Inspec, and other databases, and consulting reference lists through January 2010. Authors of 82% of included studies confirmed or supplemented extracted data. We included only randomized controlled trials that evaluated the effect on process of care or patient outcomes of a CCDSS for drug therapy management compared to care provided without a CCDSS. A study was considered to have a positive effect (i.e., CCDSS showed improvement) if at least 50% of the relevant study outcomes were statistically significantly positive.ResultsSixty-five studies met our inclusion criteria, including 41 new studies since our previous review. Methodological quality was generally high and unchanged with time. CCDSSs improved process of care performance in 37 of the 59 studies assessing this type of outcome (64%, 57% of all studies). Twenty-nine trials assessed patient outcomes, of which six trials (21%, 9% of all trials) reported improvements.ConclusionsCCDSSs inconsistently improved process of care measures and seldomly improved patient outcomes. Lack of clear patient benefit and lack of data on harms and costs preclude a recommendation to adopt CCDSSs for drug therapy management.

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Section: Introductionmentioning

confidence: 99%

Computerized clinical decision support systems for drug prescribing and management: A decision-maker-researcher partnership systematic review

et al. 2011

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“…34 In addition, assistance implementing decision support tools/prompts in electronic health records might encourage provider delivery of adherence support services. 35 Finally, since most commercial insurance plans and Medicaid programs do not reimburse for all supportive services, 36 new service reimbursement strategies might encourage providers to offer adherence support.…”

Section: Discussionmentioning

confidence: 99%

Delivery of HIV Antiretroviral Therapy Adherence Support Services by HIV Care Providers in the United States, 2013 to 2014

Weiser

Beer

Brooks

et al. 2017

J Int Assoc Provid AIDS Care

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Background Little is known about clinicians’ adoption of recommendations of the International Association of Providers of AIDS Care and others for supporting adherence to antiretroviral therapy (ART). Methods We surveyed a probability sample of US HIV care providers to estimate the percentage offering 3 ART adherence support services to most or all patients and assessed the characteristics of providers offering all 3 services (comprehensive support) to most or all patients. Results Almost all providers (95.5%) discussed ART adherence at every visit, 60.1% offered advice about tools to increase adherence, 53.5% referred nonadherent patients for supportive services, and 42.8% provided comprehensive support. Nurse practitioners were more likely to offer comprehensive support as were providers who practiced at Ryan White HIV/AIDS Program-funded facilities, provided primary care, or started caring for HIV-infected patients within 10 years. Conclusion Less than half of HIV care providers offered comprehensive ART adherence support. Certain subgroups may benefit from interventions to increase delivery of adherence support.

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“…Depending on the human-computer interaction, a CDSS can undertake different functions in the process of decision-making: reminder, advisor, critic, or pilot [11, 19, 20]. Our software will integrate the four CDSS functions:

It will visualize relevant aspects of each patient’s care using the information flags (reminder).

It will provide physician-specified dynamic action flags for age- and sex-specific preventive measures, for diagnosis-specific measures (e.g., follow-up care after cancer treatment), and/or for predefined patient groups (advisor).

It will point at quality deficits by providing dynamic action flags, e.g., if patients’ blood pressure is not controlled (critic).

It will intuitively guide the user through the system (pilot).

…”

Section: Methodsmentioning

confidence: 99%

Feasibility study of a clinical decision support system for the management of multimorbid seniors in primary care: study protocol

Weltermann

Kersting

2016

Pilot Feasibility Stud

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BackgroundCare for seniors is complex because patients often have more than one disease, one medication, and one physician. It is a key challenge for primary care physicians to structure the various aspects of each patient’s care, to integrate each patient’s preferences, and to maintain a long-term overview. This article describes the design for the development and feasibility testing of the clinical decision support system (CDSS) eCare*Seniors© which is electronic health record (EHR)-based allowing for a long-term, comprehensive, evidence-based, and patient preference-oriented management of multimorbid seniors.Methods/designThis mixed-methods study is designed in three steps. First, focus groups and practice observations will be conducted to develop criteria for software design from a physicians’ and practice assistants’ perspective. Second, based on these criteria, a CDSS prototype will be developed. Third, the prototype’s feasibility will be tested by five primary care practices in the care of 30 multimorbid seniors. Primary outcome is the usability of the software measured by the validated system usability scale (SUS) after 3 months. Secondary outcomes are the (a) willingness to routinely use the CDSS, (b) degree of utilization of the CDSS, (c) acceptance of the CDSS, (d) willingness of the physicians to purchase the CDSS, and (e) willingness of the practice assistants to use the CDSS in the long term. These outcomes will be measured using semi-structured interviews and software usage data. If the SUS score reaches ≥70 %, feasibility testing will be judged successful. Otherwise, the CDSS prototype will be refined according to the users’ needs and retested by the physicians and practice assistants until it is fully adapted to their requirements and reaches a usability score ≥70 %.DiscussionThe study will support the development of a CDSS which is primary care-defined, user-friendly, easy-to-comprehend, workflow-oriented, and comprehensive. The software will assist physicians and practices in their long-term, individualized care for multimorbid seniors.Trial registrationGerman Clinical Trials Register, DRKS00008777

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Clinical Decision Support Systems: Impacting the Future of Clinical Decision Making

Cited by 46 publications

References 31 publications

Computerized clinical decision support systems for drug prescribing and management: A decision-maker-researcher partnership systematic review

Computerized clinical decision support systems for drug prescribing and management: A decision-maker-researcher partnership systematic review

Delivery of HIV Antiretroviral Therapy Adherence Support Services by HIV Care Providers in the United States, 2013 to 2014

Feasibility study of a clinical decision support system for the management of multimorbid seniors in primary care: study protocol

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