Running head: CLINICAL DECISION SUPPORT SYSTEM 1

Clinical Decision Support Systems (CDSSs)

Name

Year

Affiliation
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Introduction

Clinical decision support systems have evolved as an integral part of

healthcare organizations. Clinical decision support system as a tool has

played a crucial role in improving the quality of care hence putting the

healthcare organization of the upper hand when it comes to managing the

patients’ lives. This tool is used in various healthcare in the United States

and reported to be with the ability to lead to cost-saving and it also aids

the healthcare organization in clearly understand the dynamics and trends

which are related to medical conditions. The practical application of this

tool is reported to be better when it comes to assimilating healthcare

changes as well as improving the health of the patients.

The tool (clinical decision support system) is good at erecting the

long-suffered problem of limited evaluation of the available data, and also

limited tools of collecting the patients' data and information which has

been the main obstacle for the past years. The exchange and utilization of

the information about health and developing governance standards could

potentially enable the healthcare organization to improve its care quality.

The tool fits in the healthcare environment by aiding the decision

making of the physicians. It is used on several occasions ranging from

drug interactions to disease prevention. The inculcation of the tool

(clinical decision support system) in the healthcare environment is the

need for care quality improvement and also the changes in healthcare law

within the healthcare organization.

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The research is aimed at evaluating the impact of clinical decision

support systems in various healthcare aspects. It is all about the

implementation of a clinical decision support system in the treatment of

Asthma

The CDS problem

The CDS problem chosen is acute and chronic care. The use of a

clinical decision support system can aid the health professional or the

physician to take on the problem when it is adequately evaluated and

properly designed. The decision made by the clinical decision support

system provides a positive outcome as regards to the performance and

quality of the patient’s care. However, there is a possibility of causing

harm if the system is not adequately evaluated and designed.

The decisions made by the clinical decision support system is based

on the ability to analyze unstructured and structured data set which

improve patient care and leads to the substantial clinical significance of

the patients. This notion provides positive outcomes and efficient

management of data in deliveries of healthcare services.

The tool allows the use of a knowledge base where the clinician or

the patient can manually enter the data into the system.

The project model is to be with a project team which is human

beings to provide the knowledge base required to coin and enter the

patients’ data into the tool for it to provide the required advice for the
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clinician to provide the actual treatment to the actual infection or disease.

The knowledge base is technical personnel with expertise knowledge of

coining, coding, and manipulating data using the tool (clinical decision

support system) to come up with the required advice about a particular

infection by matching the patients’ traits with the kind of infection or

using two or more item of the patient’s data for the clinical decision

support system to come up with the appropriate advice as pertains to the

type of disease and the actual treatment to be prescribed to the patient.

However, in some instances, the clinical professionals have started

developing a bias on the clinical decision support system. For example,

when it comes to focusing on individual clinical conditions, there is a

challenge of managing multiple conditions.

Literature review

There are many studies and kinds of literature written in clinical

decision support systems. For example, the study carried out in 2009 at

Nemours and Yale healthcare on asthma and obesity interventions.

This study was carried out to evaluate and demonstrate the

functioning of the clinical decision support system by storing, replicating

and forming the elements of clinical decision support across several

clinical sites. It was also conducted with the need for primary care and

specialty of both the institution and the clinicians.

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The works of Allen et’al, (2016) emphasises on the

effectiveness and delivery of the clinical decision support system and at

the same time, it was dependent on system utilization and a larger

workflow. However, these were realized as the challenges which the use

of the clinical decision support system faced in this project.

The study yielded various results as it pertains the use of clinical

decision support systems as follows:

It was found out that, the use of the clinical decision support

system helped doctors or the clinical professionals to distinguish among

the health conditions which may be of little variance in the kind of clinical

manifestation. This was achieved by the ability of the tool to match the

patient’s data, his or her traits with the health conditions. This prevents

incorrect tests among the patients at Yale institution. The U.S (2017)

suggests that the clinical professionals supposed to follow directive on

the clinical decision support system on which type of drug to be

administered to a particular disease or virus by matching the

characteristics of the virus with the properties of the vaccine or the drug

to be used to treat the given infection. However, the system requires a

knowledge base which is specifically skilled human beings to run the

process of data manipulation for the tool to provide the required advice.

The study conducted on the Clinical decision support system (CDS)

in nursing in 2015. This study was conducted using the narrative

literature research method to clearly evaluate the generated kinds of

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literature from the OVID, EBSCO, CINAHL, PUBMED, and MEDLINE

systems together with the internet from 2009 up to 2014.

The study obtained the results on the types, definition, use,

characteristics, benefits, barriers, and implementation of the clinical

decision support system in nursing. The effectiveness of the clinical

decision support system, the examples, the difference and the

relationship between clinical decision support system and HER

instruments were all identified and their function related to the previous

research conducted in different reviewed kinds of literature.

Characteristics of Clinical Decision Support System as

applied in nursing

There are various elements attributed or presented by the clinical

decision support system in nursing. such elements or characteristics

include; the knowledge base, results specification, the decision model,

and as well as the application environment.

The sampled number of patients that were under test were 10 and

they hard different weights and heights. In the CDS monitoring to was

used in the sampling and the patients' records were us follow:

The sampled patients information in the CDS module

Patient name Weight(kg) Height(ft)

1 mark 56 6.5
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2 Luke 60 7.0

3 john 35 5.5

The laboratory test was also taken and the results indicate 15% of

the patients were had similar body changes. The pressure levels and the

heart beating per minute of the patients were monitored by and the

outcomes were varying. The clinical decision support systems

tremendously used as integral parts of telemedicine practices of

healthcare. On top of the same resources being used, namely the digital

coding of the clinical data, there is a potential for the clinical decision

support systems to bring about the quality of telemedicine in various

cases.

The clinical decision support system is designed for computer

applications that have the potential to help the professionals in the

healthcare setting to come up with effective clinical decisions about the

patients. It is now 40 years back when the first clinical decision support

system was developed. This means that technology is an approach that

has a long way to take from not only maturing but also as a system that

can best meet the expectations of the health organizations.

Forms of Clinical Decision Support Systems in nursing

Corpus of knowledge represents the main element in all typologies

of the clinical decision support system. This is considered as vital

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expertise and the know-how which can be used for bringing healthcare to

effect. Therefore, when developing and designing, understanding the

concerns, and implementation of the clinical decision support system

representation of knowledge is taken as the primary task. Knowledge is

initially required in coding and deriving, planning, and knowledge about

future activities, and also solving the problems which would be solved by

human expertise.

The tool (clinical decision support system) is considered as a very

active knowledge system. The system generates specific advice to the

clinician about the patient by using two or more items from his or her

data. Basing on this approach, it is good to conclude that, the clinical

decision support system is a form of decision support system which

entirely depends on the use of knowledge management to achieve clinical

pieces of advice of patients' care based on various items of the patient

data.

The tool (clinical decision support system) uses various elements to

bring about workflow and clinical pieces of advice. These elements include

result specification, decision model, application environment, information

model, and knowledge base. A clinical decision support system is

considered to be suitable for hospital environments. However, its ultimate

success is achieved through many factors above usability, such as culture

and training.

The values of Clinical Decision Support System in nursing

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It leads to improved resident outcomes. The use of a clinical

decision support system is the best way of incorporating technology in the

healthcare arena to come up with the improved process of the patients’

care base. Mostly the tool (clinical decision support system), provides

specific information on residents as well as the clinical knowledge that

enables the clinicians to come up with the decision that is appropriate to

resident care at a right time.

Where there is a decline in condition, the clinical decision advice

system provides alert, constipation, loss of skin integrity, improvement in

conditions, weight gain, and weight loss, all are areas where the clinical

decision support system can provide alert on for the clinical professional

to make a right decision on which can be done to solve the problem

pertaining the patient’s health. This is made possible by tracking the

issues for the long-term hence bringing about disease management.

There is evidence that suggests that clinical based decisions (CDS)

if they are applied effectively they can manage to improve and create

opportunities in the health sector. They are able to add on the quality,

effectiveness, and safety of that is required in the healthcare sector by

the health care personnel. The associated electronic health record (EHR)

which is also adopted by the health care sector has also been good at

promoting and assuring patient care on behalf of the clinical decision

support (CDS). Due to this effort, the initiative of this clinical decision

support has been emphasized and encouraged to e applied by the

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healthcare sector to maximize efficiency, quality, and safety. The benefits

the clinical decision support have been associated with the various risks

and other safety consequences. There are various reports which have

been reporting the issues associated with the CDS. These issues have

been important for the healthcare sector since they are the basis of

improvement however much they seem to be underappreciated by the

healthcare personnel.

The issue of finding and promoting the safety of clinical decision

support has been also hard and still considered to be a work in progress.

This is because of its ability to create various opportunities that will

improve the safety and quality of the patients in the health care sector.

Never the less, when there are adoption and application of the electronic

decision support system, there is minimum detection of the drug to drug

safety of the patients. However, the expectation and trust of safety have

been seen to be high mostly in the healthcare sectors where IT has been

enabled in the service systems. Adoption and application of the IT-based

systems have been seeing as the very important contributing factor which

will manage to improve the healthcare systems and also helps in

improving the safety of the patients. The effects environment as

compared to the service environment where there is only support to the

paper of IT systems in the health care sector has been considered to be

very instrumental in addressing the situations which require adverse care

such as injuries and at times deaths.

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The works of Daniel, (2016) indicates that there are also various

significant categories of the events which are related to the information

technology that is not applicable and functional to the clinical decision

support systems (CDSS). For instance, where the clinical decision support

systems (CDSS) is not able to address various situation and conditions of

the patients in the healthcare, there will be a conflict between the

information technology and other clinical decision support systems

(CDSS) initiatives.

To manage to address the problems which are associated with the

clinical decision support systems(CDSS), there is the need for presenting

various case studies that will manage to be acknowledged and identify the

malfunctions. These case studies were conducted and addressed from the

academic or study hospital and hence they were technically approved.

The case studies managed to illustrate the various clinical decision

systems problems and the ways how they happen to occur.

However, the expectation and trust of safety have been seen to be

high mostly in the healthcare sectors where IT has been enabled in the

service systems. Adoption and application of the IT-based systems have

been seeing as the very important contributing factor which will manage

to improve the healthcare systems and also helps in improving the safety

of the patients. The effects environment as compared to the service

environment where there is only support to the paper of IT systems in the

health care sector has been considered to be very instrumental in

CLINICAL DECISION SUPPORT SYSTEM 12

addressing the situations which require adverse care such as injuries and

at times deaths.

The methodology used in collecting data as regards the

project

The study used the method of reviewing the recent publication from

(2005 and above), which contained the database on the clinical decision

support system. The publications and the perspectives of the health

providers on clinical decision support systems were also used to compare

the outcomes of published researchers.

The records of Murphy, (2014) signified that documentation of the

forms was done on the dashboards and the smart form designing

software was used to compile the information. The critical analysis was

performed in a retrospective and predictive manner. The information

gathered from the sampling was filtered to us provided on the sampling

table. The most significant format of checking the data is by the

application of the work up expert.

Barriers to clinical decision support systems

Information technology has been seen as an increasing element or

aspect which is needed by each institution of the healthcare sector. There

are various developments of information systems that have been adopted

and implemented by various institutions of the healthcare sector. These

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systems have been developed to assist the medical personnel and

clinicians in promoting safety towards decision making.

However, various barriers have been categorized according to their

determinants and also the expectancy towards their performance.

Obscurity barriers have also been categorized according to how

individuals happen to perceive them. Some of these barriers include the

following

Inadequate time to apply CDSS

This has been seen as the major barrier which happens to limit the

application of clinical decision support systems (CDSs). This barrier has

been identified and found and witnessed in various studies that were

made and attributed to identifying the importance and impact of the

decisions which are made by the clinicians. These studies managed to

identify the problem of inadequate time as an impediment to

implementing and applying the clinical decision support systems.

Poor competition of clinical demands

This barrier has also been acknowledged by the expert clinicians

who have also tried to explain that when there is obscurity in the

workflow of the clinicians, there will be incorporation and abnormal flow of

the works and practices in the healthcare sector. This will hinder various

processes in healthcare and the due course, there will be inefficiency

towards making decisions and examinations to the patients.

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There are also effort expectancy barriers which have been identified

towards the implementation of the clinical decision support systems. A

current study happens to identify that this barrier has managed to cause

other multiple barriers which were also attributed to the clinical

practitioners and their perceptions towards implementing and adopting

clinical decision supporting systems (CDSS).

According to Pierce, (2016) the implementation of CDSS identified

complexity in adopting and executing the system which limited the

application and use by the clinical practitioners. This was also linked to

the inadequacy of skills and knowledge which is required to execute and

use these clinical decision support systems. Also, this managed to hinder

the clinical practitioners' attitude towards these CDSS systems which led

to the application or installation of the systems which are not user-

friendly. Other barriers were witnessed such as uncalled for alerts, poor

designing of the CDSS systems, and inadequate flexibility of these

systems which were adopted by the healthcare sector. Social influence

barriers were also identified whereby the medical practitioners managed

to perceive others how they will manage to adopt the application of the

systems.

Example of the drug caution and the alerts

The draft of the applied programming in the CDS module is in the

format below.

Recent Warning report:

Limpidity level warnings:

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Too allergic patients:

<>apply the drug;

<>time of delay( five hours);

<> ignore the order;

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References

M. Allen and O. Pierce. (2016). Medical Errors Are No. Cause Of U.S

Deaths, Researchers Say," Health News from NPR.

M, A., Makary and M. Daniel. (2016). The medical error-the third leading

cause of death in the US, BMJ, vol. 353, no. i2139.

U. S (2017). Food and Drug Administration. Strategies to Reduce

Medication Errors: Working to Improve Medication Safety. Agency

for Healthcare Research and Quality,

E. V. Murphy (2014). Clinical Decision Support. Effectiveness in Improving

Quality Processes and Clinical Outcomes and Factors That May

Influence Success, The Journal of Biology and Medicine, vol. 87, no.

2, pp. 187-197.

J. M. Castellano., I. M. Jiminez., R. Mozos., F. C. Asso., A. C. Gonzalez

and A. G. Alberola. (2015). Symmetrical Compression Distance for

Arrhythmia Discrimination in Cloud-Based BigData Services, IEEE

Journal of Biomedical and Health Informatics, vol. 19, no. 4, pp.

1253 – 1263.