CDS is intended to improve care quality, avoid errors or adverse events, and allow care team members to be more efficient. Funding: This work was supported by a grant from the NCI (U24 CA171524; PI: L. Kushi), with no additional funding provided specifically for this work. Hepatology 2015;62:387â396. International Committee of Medical Journal Editors (ICMJE), which meets annually. Author contributions: Study concept and design: Pawloski, Brooks, Nielsen. Mark Ansermino, FFA, MMed, MSc, FRCPC, Recommendations for the Conduct, Reporting, Editing, and Publication of Scholarly Work in BMJ Open 2012;2:2. BMJ 2005;330:765. The differences in health outcomes between Web-based and paper-based implementation of a clinical pathway for radical nephrectomy. Examples of various types of clinical decision support systems include diagnostic support such as MYCIN and QMR, alerts and reminders based on the Arden Syntax, and patient management systems that use computer representations of patient care guidelines. Computer-based clinical decision support systems and patient-reported outcomes: a systematic review. eHealth for a Healthier Europe! 1. van der Lei J. Clinical decision support system Antibiotic Stewardship (ABS) Programs are implemented to ensure the rational use of antibiotics [ 7 ]. 9. Opportunities for a better use of healthcare resources. Effects of computerized clinical decision support systems on practitioner performance and patient outcomes: a systematic review. vol. However, with the burgeoning amount of data now available for each patient and the increasing body of medical evidence, we need tools to help us make rational decisions based on all this information. Impact of electronic chemotherapy order forms on prescribing errors at an urban medical center: results from an interrupted time-series analysis. 2011; 18(3): 327-334. Medical Journals . This question is for testing whether or not you are a human visitor and to prevent automated spam submissions. Clinical decision support systems (CDSSs) have been hailed for their potential to reduce medical errors1 and increase health care quality and efficiency.2At the same time, evidence-based medicine has been widely promoted as a means of improving clinical outcomes, where evidence-based medicine refers to the practice of medicine based on the best available scientific evidence. Building a Safer System: A National Integrated Strategy for Improving Patient Safety in Canadian Health Care. Evid Rep Technol Assess (Full Rep) 2012;203:1â784. J Am Med Inform Assoc 1997;4:S20-S30. Making electronic prescribing alerts more effective: scenario-based experimental study in junior doctors. The study team made every effort to identify all publications meeting the inclusion criteria. When the order is entered into the computer, the physician is reminded of the exact elements of the evidence-based criteria for such an order (the Ottawa Ankle Rules). Reducing overuse of colony-stimulating factors in patients with lung cancer receiving chemotherapy: evidence from a decision support-enabled program. If the inline PDF is not rendering correctly, you can download the PDF file here. 9, 10 Several such systems have been implemented for asthma management, 11–16 but overall results have been mixed. The types of CDSS available are as broad as human ingenuity allows: from personal digital assistant applications customized by a single clinician to multihospital mainframe-based surveillance systems meant to assure care for thousands of patients. The types of CDSS available are as broad as human ingenuity allows: from personal digital assistant applications customized by a single clinician to multihospital mainframe-based surveillance systems meant to assure care for thousands of patients. We critically appraised and synthesized the published medical literature to answer the objective question, âWhat evidence supports the use of CDS systems for diagnosis, treatment, and supportive care in clinical oncology?â A CDS system was defined as any electronic system in which characteristics of individual patients are used to generate patient-specific assessments or recommendations that are then presented to clinicians to help with clinical decision-making.1. of Medical Journal Editors (ICMJE) recommends the following citation style, which is the now nearly universally The largest category of studies included in our review comprises studies evaluating the use of CPOE systems in oncology care. Harris AD, McGregor JC, Perencevich EN, . A clinical decision support system is one of the key components for reaching compliance for Meaningful Use. J Am Med Inform Assoc 2003;10:154-165. In many clinical decision support systems, a two-layer knowledge base model (disease-symptom) of rule reasoning is used. Clinical decision support is any tool that provides clinicians, administrative staff, patients, caregivers, or other members of the care team with information that is filtered or targeted to a specific person or situation. J Am Med Inform Assoc 2003;10:94-107. Voeffray M, Pannatier A, Stupp R, . to help authors and editors create and distribute accurate, clear, easily accessible reports of biomedical studies. Accessed September 13, 2018. Strengths of this systematic review include the study team, comprising a research librarian, 2 practicing oncologists, and an oncology clinical pharmacist. Characteristics of Studies Assessing CDS Systems in Oncology Clinical Care, Rate of prescription errors was the primary study outcome in 9 of the 12 studies evaluating CPOE.20â31 Although errors were defined differently among studies, prescription errors were reduced in all of them20,23â25,27â31: 1 evaluated medication-related safety events, demonstrating fewer events with use of CDS22; 2 evaluated pharmacy workflow, with 1 showing decreased workflow fragmentation and increased continuous task time with CPOE26; and another study showed increased order review time with CPOE.21, CDS systems that could be classified as clinical pathways for care delivery processes were assessed in 6 of the 24 evaluated studies.32â37 The primary outcome for each of these studies was the association of the clinical pathway CDS system with receipt of guideline-concordant or pathway-recommended care. 1,2 These systems require computable biomedical knowledge, person-specific data, and a reasoning or inferencing mechanism that combines knowledge and data … 6. Our systematic review is reported >10 years after a call to action by the AMIA regarding the use of CDS.4 The call included directives for achieving desirable levels of patient safety, care quality, patient-centeredness, and cost-effectiveness. Ann Intern Med 2012;157:29â43. J Am Med Inform Assoc 2016;23:420â427. Computer-Based Delivery of Health Evidence: A Systematic Review of Randomised Controlled Clinical Trials and Systematic Reviews of the Effectiveness on the Process of Care and Patient Outcomes. In the coming years, provincial and federal health ministries will invest billions of dollars in new health information systems. Using an enhanced oral chemotherapy computerized provider order entry system to reduce prescribing errors and improve safety. Osheroff JA, Teich JM, Middleton B, . Arch Intern Med 2003;163:1409â1416. U.S. National Library of Medicine. CDS systems with all 4 features were associated with significant improvements in clinical practice. The question is surprisingly hard to answer. MYCIN was developed in the 1970s to help clinicians choose antibiotics for bacteremia or meningitis. Clinicians are also best placed to decide how CDSS should be implemented in local care environments. Castaneda C, Nalley K, Mannion C, . Vancouver Group. National Library of Medicine (NLM), were first published in 1979.  The authors found that clinician or patient compliance with evidence-based recommendations improved only a modest amount: from 52% without to 57% with a system. Clinical Decision Support. Beriwal S, Rajagopalan MS, Flickinger JC, . Int J Qual Health Care 2011;23:36â43. Studies of decision aids intended primarily for patient use were excluded. Two systematic reviews that assessed CPOE for inpatients in medicine or intensive care units12 and at the point of care in any clinical setting13 demonstrated a clear benefit to implementing CDS. The potential exists for bias, including searching, exclusion criteria, assembling, and publication, although all efforts were made to minimize this where possible. To Err Is Human: Building a Safer Health System. Of the 120 studies identified before 1995, none met the predefined inclusion criteria and therefore they were not included in this analysis. Disease management systems are specialized CDSS that help clinicians and patients negotiate complex treatment algorithms for conditions such as asthma, hypertension, diabetes, and hyperlipidemia. Roshanov PS, Fernandes N, Wilczynski JM, . JAMA 1999;282:1851-1856. Medical Informatics: Computer Applications in Health Care and Biomedicine. However, the effects of the intervention were conflicting and uncertain. A total of 23 studies reported improvement in key study outcomes with use of oncology CDS systems, and 12 studies assessing the systems for computerized chemotherapy order entry demonstrated reductions in prescribing error rates, medication-related safety events, and workflow interruptions. The Vancouver Group expanded and evolved into the We urge clinicians to identify opportunities for CDSS and to advocate within their health care settings for the development of systems that bring about meaningful improvement of health outcomes. A physician orders an X-ray for a patient who has inverted her ankle. 12. BMJ 2013;346:f657. Non-intercepted dose errors in prescribing anti-neoplastic treatment: a prospective, comparative cohort study. Chang PL, Li YC, Lee SH. Qual Saf Health Care 2006;15:418â421. Diabetes systems might be the best example of cases where patient-specific data, such as blood glucose measurements and food intake, are used to generate customized educational modules and detailed dietary recommendations. To optimize care pathways with an intelligent decision support system aimed at facilitating diagnosis and therapeutic decisions along disease-specific pathways. While implementing the IF-THEN-ELSE rule illustrated by the Brigham and Women’s Hospital hypokalemia/digoxin example is relatively straightforward, the programming of guidelines with their multiple, often subjective decision points tests the limits of scientific disciplines such as decision analysis and knowledge representation. However, the labor-intensive, often biased process of entering findings limits its utility. HealthIT.gov website. Above is the information needed to cite this article in your paper or presentation. Assessment of efficiency and safety of the comprehensive Chemotherapy Assistance Program for ordering oncology medications. CDDS interventions found a significant impact on multiple outcomes relevant to antibiotic stewardship. Systematic review: impact of health information technology on quality, efficiency, and costs of medical care. A New Market Study, titled "Clinical Decision Support Systems (CDSS) Market Upcoming Trends, Growth Drivers and Challenges" has been featured on WiseGuyReports. In general, the outcomes associated with use of clinical pathway systems were compared with usual care; however, one study compared use of an electronic clinical pathway with a paper pathway.34 Most studies were framed as reporting favorable outcomes, including reduced acute care use,32,35 increased guideline concordance and reduced symptoms,33 improved identification of eligible subjects for clinical trial participation,36 and improved hemoglobin levels among patients with anemia.37 The comparison between web- and paper-based pathway systems did not show a significant difference in pathway deviations between them.34, The remaining 6 studies assessed CDS systems in CPGs (n=2),38,39 PROs (n=3),40â42 and oncology-specific prescriber alerts (n=1).43 One study evaluated CPG concordance with CDS and demonstrated a significant increase in guideline adherence (P38 Furthermore, adherence to CPGs with CDS system advice was >90% when the CDS tool included CPG recommendations.39 CDS tools for obtaining PROs and reporting the results to clinicians showed increased discussion of symptoms and quality-of-life issues (P=.03) and symptom monitoring during routine clinical care.40â42 Patients reported a high ease of use and minimal time required; however, patient satisfaction was similar between intervention and control groups. J Am Med Inform Assoc 2012;19:980â987. Mattsson TO, Holm B, Michelsen H, . How effective are clinical pathways with and without online peer-review? Electronic clinical decision support (CDS) systems can potentially improve cancer care quality and safety. Here the information in the message is compared with all relevant rules. Clinicians and researchers have long envisioned the day when computers could assist with difficult decisions in complex clinical situations. After review and screening of titles and abstracts, 83 full-text articles were assessed for eligibility, and 24 studies were included in the final analysis. Proc AMIA Symp 1999:221-225. Recommendations for the Conduct, Reporting, Editing, and Publication of Scholarly Work in Small MD, Barrett A, Price GM. The Arden Syntax is a quasi-programming language that allows the encoding of decision rules into a computer-readable format. A before-after study using OncoDoc, a guideline-based decision support-system on breast cancer management: impact upon physician prescribing behaviour. For optimal retrieval, all terms were supplemented with relevant title and text words. Results: Electronic database searches yielded 2,439 potentially eligible papers, with 24 studies included after final review. J Oncol Pharm Pract 2002;8:119â126. BMC Health Serv Res 2010;10:2. A major gap in CDS system use exists across the spectrum of clinical oncology care, and further development of CDS tools is warranted. Is living near power lines bad for our health? Ann Oncol 2015;26:981â986. 11. Kaushal R, Shojania KG, Bates DW. However, not all studies evaluating CDS systems have shown clinical practice improvements.48 Thus, it is imperative that systems and tools, both commercially and locally developed, be assessed for their effectiveness and impact on patient outcomes. J Am Med Inform Assoc 2006;13:16â23. 5 , June 5 In the report, the agency described clinical decision support as technology that “provides healthcare providers and patients with knowledge and person-specific information, intelligently filtered or presented at … 13. Anderson JA, Willson P. Clinical decision support systems in nursing: synthesis of the science for evidence-based practice. Berner ES. A roadmap for national action on clinical decision support. Computerized provider order entry in pediatric oncology: design, implementation, and outcomes, Assessment of efficiency and safety of the comprehensive Chemotherapy Assistance Program for ordering oncology medications, Using an enhanced oral chemotherapy computerized provider order entry system to reduce prescribing errors and improve safety, Impact of electronic chemotherapy order forms on prescribing errors at an urban medical center: results from an interrupted time-series analysis, Computerized prescriber order entry implementation in a physician assistant-managed hematology and oncology inpatient service: effects on workflow and task switching, Impact of computerised chemotherapy prescriptions on the prevention of medication errors, Non-intercepted dose errors in prescribing anti-neoplastic treatment: a prospective, comparative cohort study, Reduction in chemotherapy order errors with computerized physician order entry, The impact of computerized prescribing on error rate in a department of Oncology/Hematology, Effect of computerisation on the quality and safety of chemotherapy prescription, How effective are clinical pathways with and without online peer-review? Health care organizations are turning to electronic clinical decision support systems (CDSSs) to increase quality of patient care and promote a safer environment. There are various types of CDSS implementations, both active and passive (provider initiated). J Oncol Pract 2013;9:e103â114. Clinical decision support systems (CDSS—defined as any system designed to improve clinical decision-making related to diagnostic or therapeutic processes of care—were initially developed more than 40 years ago, and they have become increasingly sophisticated over time. 1 The authors found no significant improvement in clinical outcomes in the subset of 30 trials that included them. Meisenberg BR, Wright RR, Brady-Copertino CJ. Clinical decision support (CDS) systems are a necessary component that assist healthcare organisations to reach enhanced digital maturity, by enabling clinicians to provide evidence-based care for improved patient outcomes and reduced treatment costs. CDS systems incorporated into clinical pathways have been associated with increased guideline adherence,32â37 demonstrating the benefit they can provide to clinicians, and consistent with findings of previous systematic reviews also showing a positive impact on guideline adherence.10,44 Three studies included in our analysis evaluated the use of CDS systems for PROs, and all demonstrated benefit for â¥1 outcome.40â42 These findings differ somewhat from those of a systematic review of 15 studies that assessed the effect of CDS systems on PROs, which showed a positive effect on symptoms in 3 studies (20%).45 A CDS system used with prescriber alerts demonstrated a positive impact, which is consistent with findings of a previous study.43,46, The findings are also consistent with those of a meta-analysis assessing the impact of health information technology (HIT) on cancer care from 2000 to June 2014.47 CDS systems were the most common (66%) HIT intervention identified and were implemented across several cancer types, including breast, colorectal, and prostate, for detection, diagnosis, and treatment but not for survivorship or end-of-life care. 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