A Medical Informatics Perspective on Clinical Decision Support Systems

 

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Summary

Objective: To summarize excellent research and to select best papers published in 2012 in the field of computer-based decision support in healthcare.

Methods: A bibliographic search focused on clinical decision support systems (CDSSs) and computer provider order entry was performed, followed by a double-blind literature review.

Results: The review process yielded six papers, illustrating various aspects of clinical decision support. The first paper is a systematic review of CDSS intervention trials in real settings, and considers different types of possible outcomes. It emphasizes the heterogeneity of studies and confirms that CDSSs can improve process measures but that evidence lacks for other types of outcomes, especially clinical or economic. Four other papers tackle the safety of drug prescribing and show that CDSSs can be efficient in reducing prescription errors. The sixth paper exemplifies the growing role of ontological resources which can be used for several applications including decision support.

Conclusions: CDSS research has to be continuously developed and assessed. The wide variety of systems and of interventions limits the understanding of factors of success of CDSS implementations. A standardization in the characterization of CDSSs and of intervention trial reporting will help to overcome this obstacle.

• References

• 1 Hunt DL, Haynes RB, Hanna SE, Smith K. Effects of computer-based clinical decision support systems on physician performance and patient outcomes. JAMA 1998; 280 (15) 1339-46.
  CrossrefPubMedGoogle Scholar
• 2 Haynes RB, Wilczynski NL. CCDSS Systematic Review Team. Effects of computerized clinical decision support systems on practitioner performance and patient outcomes: Methods of a decision-maker-researcher partnership systematic review. Implement Sci. 2010 5. (1) 12.
  PubMedGoogle Scholar
• 3 Bright TJ, Wong A, Dhurjati R, Bristow E, Bastian L, Coeytaux RR. et al. Effect of clinical decision-support systems: A systematic review. Ann Intern Med 2012; 157 (1) 29-43.
  CrossrefPubMedGoogle Scholar
• 4 Pruszydlo MG, Walk-Fritz SU, Hoppe-Tichy T, Kaltschmidt J, Haefeli WE. Development and evaluation of a computerised clinical decision support system for switching drugs at the interface between primary and tertiary care. BMC Med Inform Decis Mak 2012; 12: 137.
  CrossrefPubMedGoogle Scholar
• 5 Rattinger GB, Mullins CD, Zuckerman IH, Onukwugha E, Walker LD, Gundlapalli A. et al. Sustainable strategy to prevent misuse of antibiotics for acute respiratory infections. PLoS One 2012; 7 (12) e51147.
  CrossrefPubMedGoogle Scholar
• 6 Riano D, Real F, Lopez-Vallverdu JA, Campana F, Ercolani S, Mecocci P. et al. An ontology-based personalization of health-care knowledge to support clinical decisions for chronically ill patients. J Biomed Inform 2012; 45 (3) 429-46.
  CrossrefPubMedGoogle Scholar
• 7 Tamblyn R, Eguale T, Buckeridge DL, Huang A, Hanley J, Reidel K. et al. The effectiveness of a new generation of computerized drug alerts in reducing the risk of injury from drug side effects: a cluster randomized trial. J Am Med Inform Assoc 2012; 19 (4) 635-43.
  CrossrefPubMedGoogle Scholar
• 8 Westbrook JI, Reckmann M, Li L, Runciman WB, Burke R, Lo C. et al. Effects of two commercial electronic prescribing systems on prescribing error rates in hospital in-patients: A before and after study. PLos Med 2012; 9 (1) e1001164.
  CrossrefPubMedGoogle Scholar
• 9 Kortteisto T, Komulainen J, Mäkelä M, Kunnamo I, Kaila M. Clinical decision support must be useful, functional is not enough: a qualitative study of computer-based clinical decision support in primary care. BMC Health Serv Res 2012; 12: 349.
  CrossrefPubMedGoogle Scholar
• 10 Eslami S, Abu-Hanna A, Schultz MJ, de Jonge E, de Keizer NF. Evaluation of consulting and critiquing decision support systems: Effect on adherence to a lower tidal volume mechanical ventilation strategy. J Crit Care 2012; 27 (4) 425-e1.
  PubMedGoogle Scholar
• 11 Rodríguez-González A, Emilio Labra-Gayo J, Colomo-Palacios R, Mayer MA, Miguel Gómez-Berbís J, García-Crespo A. SeDeLo: Using semantics and description logics to support aided clinical diagnosis. J Med Syst 2012; 36 (4) 2471-81.
  CrossrefPubMedGoogle Scholar
• 12 Grando MA, Glasspool D, Boxwala A. Argumentation logic for the flexible enactment of goal-based medical guidelines. J Biomed Inform 2012; 45 (5) 938-49.
  CrossrefPubMedGoogle Scholar
• 13 Grigull L, Lechner WM. Supporting diagnostic decisions using hybrid and complementary data mining applications: a pilot study in the pediatric emergency department. Pediatr Res 2012; 71 (6) 725-31.
  CrossrefPubMedGoogle Scholar
• 14 Djulbegovic B, Hozo I, Beckstead J, Tsalatsanis A, Pauker SG. Dual processing model of medical decision-making. BMC Med Inform Dec Mak 2012; 12: 94.
  PubMedGoogle Scholar
• 15 Wu HW, Davis PK, Bell DS. Advancing clinical decision support using lessons from outside of healthcare: an interdisciplinary systematic review. BMC Med Inform Decis Mak 2012; 12: 90.
  CrossrefPubMedGoogle Scholar
• 16 Ash JS, Sittig DF, Guappone KP, Dykstra RH, Richardson J, Wright A. et al. Recommended practices for computerized clinical decision support and knowledge management in community settings: a qualitative study. BMC Med Inform Decis Mak 2012; 12: 6.
  CrossrefPubMedGoogle Scholar
• 17 Augestad KM, Berntsen G, Lassen K, Bellika JG, Wootton R, Lindsetmo RO. et al. Standards for reporting randomized controlled trials in medical informatics: a systematic review of CONSORT adherence in RCTs on clinical decision support. J Am Med Inform Assoc 2012; 19 (1) 13-21.
  CrossrefPubMedGoogle Scholar