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Study on clinical decision support systems finds pros and cons

A years-long study on clinical decision support found it can offer value during care, but bring harm when used improperly.

Differences in clinical decision support systems technology, such as those with separate EHR systems, can cause integration challenges, according to the findings of a long-term study issued by the Agency for Healthcare Research and Quality.

Moreover, inconsistencies in clinical workflows required revision and significant re-engineering to ensure that the clinical decision support (CDS) tool captured the data elements in the appropriate order to work. The projects also exposed some legal issues around intellectual property and liability.

In the summer of 2007, the Agency for Healthcare Research and Quality (AHRQ) began accepting proposals to study of using of CDS in clinical settings. The researchers' goal was to identify the value of CDS as part of patient care. In the intervening seven years, two proposal awardees developed and carried out their implementations and now their findings have been published.

Research sites: Yale, Brigham and Women's

The two demonstration projects AHRQ chose were Brigham and Women's Hospital Clinical Decision Support Consortium (CDSC) and the Yale School of Medicine GuideLines Into DEcision Support (GLIDES) project. After years of developing, implementing and studying their effectiveness of the tools, the study found CDS tools indeed can make a difference in patient care.

Both CDSC and GLIDES provided "the ability to translate evidence-based knowledge into actionable guidance for clinical care." Researchers revealed that when teams included guideline developers and professional associations, the CDS tool being used helped create significant improvements in quality of care, and yielded higher quality data reporting.

It was also made clear in the AHRQ report that clinical decision support helped further develop data specifications for EHRs. The report also indicated that using Web services to manage content has helped maintain a centralized library of verified CDS content that has been shared among multiple entities.

CDS: Do it right, despite implementation challenges

"Getting CDS wrong will not be the equivalent of not providing any CDS. Rather, there is a real risk of inefficiency and patient harm," said Matthew B. Weinger, M.D., M.S., a member of the technical expert panel participating in the study.

Clinical decision support systems are being used by providers in diagnostics and as part of effective treatment plans. The growth of electronic health records, as well as the challenge of managing patients with complex conditions, has justified the need for new technology to help support physicians. Vendors or hospitals designing CDS tools would be wise to address the challenges outlined in the AHRQ study -- including how to handle complex conditions that trigger multiple CDS responses -- to ensure the safety of patients and the advancement of these tools.

While there were many documented enhancements to patient care in the two CDS implementations, Yale and Brigham and Women's also found there were implementation challenges. One issue stemmed from the differences in IT infrastructure across the different implementation sites. 

Many hospitals are leveraging clinical decision support systems to assist their physicians. These tools can provide reminders and alerts to care providers and customized order sets based on patients' specific conditions. CDS provides these recommendations based on patients' health data and its internal knowledge base. With their ability to process and analyze large data sets and evidence-based rules from medical science, CDS tools are able to assist physicians and nurses with diagnosis and treatment.

About the author:
Reda Chouffani is vice president of development at Biz Technology Solutions Inc., which provides software design, development and deployment services for the healthcare industry. Let us know what you think about the story; email
 [email protected] or contact @SearchHealthIT on Twitter.

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