The Imperative for Patient-Centered Clinical Decision Support

Marcial, Laura Haak; Richardson, Joshua E.; Lasater, Beth; Middleton, Blackford; Osheroff, Jerome A.; Kawamoto, Kensaku; Ancker, Jessica S.; Leeuwen, Danny Van; Lomotan, Edwin A.; Al-Showk, Shafa; Blumenfeld, Barry H.

doi:10.5334/egems.259

Cited by 21 publications

(22 citation statements)

References 23 publications

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“…Shared-decision-making between patients and clinicians can be seriously compromised without effective mechanisms to aid understanding of benefits and risks for outcome probabilities. Research in clinical decision support has shown that their use can reduce costs, improve quality of care and reduce medical errors in clinical settings [60].…”

Section: Effects Of the Cdsss In The Populationmentioning

confidence: 99%

Clinical Decision Support Systems in Breast Cancer: A Systematic Review

Mazo

Kearns

Mooney

et al. 2020

Cancers

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Breast cancer is the most frequently diagnosed cancer in women, with more than 2.1 million new diagnoses worldwide every year. Personalised treatment is critical to optimising outcomes for patients with breast cancer. A major advance in medical practice is the incorporation of Clinical Decision Support Systems (CDSSs) to assist and support healthcare staff in clinical decision-making, thus improving the quality of decisions and overall patient care whilst minimising costs. The usage and availability of CDSSs in breast cancer care in healthcare settings is increasing. However, there may be differences in how particular CDSSs are developed, the information they include, the decisions they recommend, and how they are used in practice. This systematic review examines various CDSSs to determine their availability, intended use, medical characteristics, and expected outputs concerning breast cancer therapeutic decisions, an area that is known to have varying degrees of subjectivity in clinical practice. Utilising the methodology of Kitchenham and Charter, a systematic search of the literature was performed in Springer, Science Direct, Google Scholar, PubMed, ACM, IEEE, and Scopus. An overview of CDSS which supports decision-making in breast cancer treatment is provided along with a critical appraisal of their benefits, limitations, and opportunities for improvement.

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Section: Effects Of the Cdsss In The Populationmentioning

confidence: 99%

Clinical Decision Support Systems in Breast Cancer: A Systematic Review

Mazo

Kearns

Mooney

et al. 2020

Cancers

View full text Add to dashboard Cite

show abstract

“…The specific needs of different stakeholders have to be considered, e.g. patients and their healthcare professionals, EHR vendors and Standard Developing Organizations (SDOs), as well as healthcare policymakers [63].…”

Section: Success Factors For the Implementation Of Cdsssmentioning

confidence: 99%

Guiding principles for the use of knowledge bases and real-world data in clinical decision support systems: report by an international expert workshop at Karolinska Institutet

Hoffmann

Stichele

Bates

et al. 2020

Expert Review of Clinical Pharmacology

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Introduction: Technical and logical breakthroughs have provided new opportunities in medicine to use knowledge bases and large-scale clinical data (real-world) at point-of-care as part of a learning healthcare system to diminish the knowledge-practice gap. Areas covered: The article is based on presentations, discussions and recommendations from an international scientific workshop. Value, research needs and funding avenues of knowledge bases and access to real-world data as well as transparency and incorporation of patient perspectives are discussed. Expert opinion: Evidence-based, publicly funded, well-structured and curated knowledge bases are of global importance. They ought to be considered as a public responsibility requiring transparency and handling of conflicts of interest. Information has to be made accessible for clinical decision support systems (CDSS) for healthcare staff and patients. Access to rich and real-world data is essential for a learning health care ecosystem and can be augmented by data on patient-reported outcomes and preferences. This field can progress by the establishment of an international policy group for developing a best practice guideline on the development, maintenance, governance, evaluation principles and financing of open-source knowledge bases and handling of real-world data.

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“…CDSSs are multifaceted and incorporate individualized patient recommendations through information technology algorithms enhancing clinical decision-making skills. [29][30][31][32] CDSS alerts can also evaluate and improve metric performance. 33 These algorithms can facilitate cancer screening recommendations based on a patient's individualized health risk and comorbidities, to guide the provider on specific orders.…”

Section: Clinical Decision Support Systemsmentioning

confidence: 99%

Understanding User Acceptance of Clinical Decision Support Systems to Promote Increased Cancer Screening Rates in a Primary Care Practice

Kelsey

Njeru

Chaudhry

et al. 2020

J Prim Care Community Health

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Objective: Clinical decision support systems (CDDSs) in the electronic medical record (EMR) have been implemented in primary care settings to identify patients due for cancer screening tests, while functioning as a real time reminder system. There is little known about primary care providers (PCPs) perspective or user acceptance of CDSS. The purpose of this study was to investigate primary care provider perceptions of utilizing CDSS alerts in the EMR to promote increased screening rates for breast cancer, cervical cancer, and colorectal cancer. Methods: An electronic survey was administered to PCPs in a Midwest Health Institution community internal medicine practice from September 25, 2019 through November 27, 2019. Results: Among 37 participants (9 NP/Pas and 28 MD/DOs), the NP/PA group was more likely to agree that alerts were helpful (50%; P-value = .0335) and the number of alerts (89%; P = .0227) in the EMR was appropriate. The NP/PA group also was more likely to find alerts straightforward to use (78%, P = .0239). Both groups agreed about feeling comfortable using the health maintenance alerts ( MD/DO = 79%; NP/PA = 100%). Conclusion: CDSSs can promote and facilitate ordering of cancer screening tests. The use of technology can promptly identify patients due for a test and act as a reminder to the PCP. PCPs identify these alerts to be a beneficial tool in the EMR when they do not interrupt workflow and provide value to patient care. More work is needed to identify factors that could optimize alerts to be even more helpful, particularly to MD/DO groups.

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The Imperative for Patient-Centered Clinical Decision Support

Cited by 21 publications

References 23 publications

Clinical Decision Support Systems in Breast Cancer: A Systematic Review

Clinical Decision Support Systems in Breast Cancer: A Systematic Review

Guiding principles for the use of knowledge bases and real-world data in clinical decision support systems: report by an international expert workshop at Karolinska Institutet

Understanding User Acceptance of Clinical Decision Support Systems to Promote Increased Cancer Screening Rates in a Primary Care Practice

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