Effects of Computer-based Clinical Decision Support Systems on Clinician Performance and Patient Outcome: A Critical Appraisal of Research

Johnston, Mary

doi:10.7326/0003-4819-120-2-199401150-00007

Cited by 599 publications

(313 citation statements)

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“…Compared with other existing approaches of clinical decision support systems, such as reminder system and computerised physician order entry system (McDonald, 1976;Johnston et al, 1994;Elson & Connelly, 1995;Bates et al, 2001), this approach and result has demonstrated a better pathway knowledge support in the whole treatment process as well as better improvement in medical error and length of stay. Moreover, this study also contributes to the design approach of the socio-technical system by integrating the informal, formal and technical levels in the organisation.…”

Section: Discussionmentioning

confidence: 99%

“…Currently, IT has been recognised by many researchers as a useful tool for clinical decision support. They are used to improve medical performance and pathway compliance by delivering relevant advice in a timely manner (Johnston et al, 1994;Elson & Connelly, 1995). These capabilities rely on the structured clinical data and rules that trigger appropriate recommendations (Zielstorff, 1998;Lenz & Reichert, 2005).…”

Section: Related Researchmentioning

confidence: 99%

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Integrated clinical pathway management for medical quality improvement – based on a semiotically inspired systems architecture

Liu

Yang

et al. 2014

European Journal of Information Systems

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Clinical pathway is an approach to standardise care processes to support the implementations of clinical guidelines and protocols. It is designed to support the management of treatment processes including clinical and non-clinical activities, resources and also financial aspects. It provides detailed guidance for each stage in the management of a patient with the aim of improving the continuity and coordination of care across different disciplines and sectors. However, in the practical treatment process, the lack of knowledge sharing and information accuracy of paper-based clinical pathways burden health-care staff with a large amount of paper work. This will often result in medical errors, inefficient treatment process and thus poor quality medical services. This paper first presents a theoretical underpinning and a co-design research methodology for integrated pathway management by drawing input from organisational semiotics. An approach to integrated clinical pathway management is then proposed, which aims to embed pathway knowledge into treatment processes and existing hospital information systems. The capability of this approach has been demonstrated through the case study in one of the largest hospitals in China. The outcome reveals that medical quality can be improved significantly by the classified clinical pathway knowledge and seamless integration with hospital information systems.

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Section: Discussionmentioning

confidence: 99%

Section: Related Researchmentioning

confidence: 99%

Integrated clinical pathway management for medical quality improvement – based on a semiotically inspired systems architecture

Liu

Yang

et al. 2014

European Journal of Information Systems

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“…Overall, it seems that systems that are problem-orientated, and systems that serve to alert and remind, have a better success than large diagnostic ones [14,23]. Our system does not interfere with the whole diagnostic process.…”

Section: Discussionmentioning

confidence: 86%

Improving empirical antibiotic treatment: prospective, nonintervention testing of a decision support system

Leibovici

Gitelman

Yehezkelli

et al. 1997

Journal of Internal Medicine

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Objectives. Develop a problem-orientated and databased decision support system (DSS) to improve empirical antibiotic treatment, and compare the performance of the system to that of the physician.Design. The DSS was tested in a prospective, noninterventional, comparative cohort study. Setting. University hospital in Israel. Subjects. Consecutive patients (n ϭ 496) in four departments of internal medicine suspected of harboring a moderate to severe bacterial infection. Interventions. None. Main outcome measures. The percentage of appropriate empirical antibiotic treatments. Results. Out of 496 patients included in the study, 219 had positive cultures or serological tests. The physicians prescribed inappropriate empirical antibiotic treatment in 91 of 219 patients (42%); whilst the recommendations of the system were inappropriate in 50 patients (23%) (P Ͻ 0.05). Superfluous treatment was prescribed in 15% of patients by the physician, and in 11% by the system. Out of the 91 patients given inappropriate treatment by the physician, the DSS advised treatment to which the pathogens were susceptible in 61 patients. The advantage of the DSS over the physician was most evident in multiresistant gramnegative isolates, enterococci and Staphylococcus aureus.Out of the 277 patients with negative cultures, the DSS advised narrower-spectrum antibiotic treatment than prescribed by the physicians in 27% of patients, and broader-spectrum in 13%. Conclusion. A problem-orientated, data-based DSS outperformed physicians in the choice of appropriate empirical antibiotic treatment, and recommended less broad-spectrum antibiotics.

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“…While it is clear that no computer system can replace the physician and her complex reasoning about the patient's state, the positive effect of clinical guidelines on medical practice has been demonstrated by several studies [1].…”

Section: Introductionmentioning

confidence: 99%

Combining diagnosis and treatment using asbru

Seyfang

Miksch

Marcos

2002

International Journal of Medical Informatics

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Effects of Computer-based Clinical Decision Support Systems on Clinician Performance and Patient Outcome: A Critical Appraisal of Research

Abstract: Strong evidence suggests that some CDSSs can improve physician performance. Additional well-designed studies are needed to assess their effects and cost-effectiveness, especially on patient outcomes.

Cited by 599 publications

References 0 publications

Integrated clinical pathway management for medical quality improvement – based on a semiotically inspired systems architecture

Integrated clinical pathway management for medical quality improvement – based on a semiotically inspired systems architecture

Improving empirical antibiotic treatment: prospective, nonintervention testing of a decision support system

Combining diagnosis and treatment using asbru

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