----------------------------
Table of Contents
----------------------------
Introduction
System Design and Real-World Effectiveness
Data Types and Research Support
Opportunities
System Enhancement
Conclusion
References
Information systems are a rapidly developing technology being integrated into the
healthcare sector,
which seeks to modernize the operational and clinical capacities of medical
facilities and its staff.
A technology known as the clinical decision support (CDS) system can combine
research, protocols,
informatics, and patient data into databases. Its function is critical in guiding
and supporting medical
professionals during the process of patient evaluation and treatment.
An informed decision-making process drastically improves patient outcomes by
limiting human error
as well as improving both the speed and effectiveness of treatment options. The CDS
system was chosen
since the nursing staff is faced with many decisions when working with and
treating patients.
Nurses must follow complex protocols and are at the forefront of hospital
operations in inpatient care.
I believe that the system has high potential in the healthcare field; however, it
requires further
development within the realm of artificial intelligence and should be carefully
monitored to avoid
complete dependence of human judgment on the technology. The CDS system is a
necessary integration
into the hospital information system network since it is a critical supplementary
tool for the
improvement of quality in patient outcomes.
System Design and Real-World Effectiveness
CDS systems are closely intertwined with electronic health records (EHRs), using
patient-specific data, personal
information, and medical history. The system is designed to provide a series of
recommended actions based on the
available patient data as well as any additional information input by the staff
based on examination and situational
evidence (Byrne et al., 2014). Expenses are reduced by improving the efficiency
and quality of treatment.
From a medical perspective, the system can prevent errors, provide warnings, and
ensure adherence to clinical guidelines.
In terms of hospital operations, the system can reduce the length of stay, manage
diagnostic testing, and aid in the
implementation of preventive care (Musen, Middleton, & Greenes, 2014).
In a real-world setting, the system is effective on a basic level of providing
alerts and recommendations based on input
patient data. However, it lacks the integrated interaction in the healthcare
process for which it is being designed.
There are some challenges, such as interoperability issues with software and IT
infrastructure in each individual
healthcare organization. Furthermore, there are difficulties adopting CDS into
clinical workflows as well as ensuring
its validity due to rapidly changing protocols and available medical information.
Data Types and Research Support
The use of the CDS information system from a technical standpoint consists of using
data mining in order to analyze
patient history or records and compare them to relevant medical information
available in the system’s databases.
Patient data may include demographic information, diagnoses, medications,
diagnostic test results, and allergies.
The system actively evaluates its knowledge base to present a variety of clinical
interventions, including symptoms,
treatment protocols, care plans, event-driven alerts, alerts (such as drug
interactions), documentation, data reports, and references (Byrne et al., 2014).
Although the CDS system is based on providing research data to medical
professionals, it has been actively used for various investigations revolving
around healthcare practices. In recent years, a number of research studies have
been conducted to analyze the effects of CDS integration on
changes in hospital practices and its impacts on patient care. Driven by nationwide
initiatives, many organizations are adopting evidence-based
medicine, which CDS can provide. Furthermore, the system is used to analyze the
efficiency of clinical workflow and how its methodology can have
clinical and economic effects on healthcare.
Opportunities
Nurses are the largest group of employees in the healthcare sector, directly
working with patients, and are the primary users of the CDS information
systems. Many of the information technologies have been adopted by executives in an
attempt to increase productivity and eliminate various burdens
that make nursing a high-stress profession. Medical professionals, including
nurses, participate in the design of CDS systems, especially in many
patient-related aspects such as patient adherence to disease management.
Nurse leaders, considering experience and feedback from colleagues, participate in
councils and initiatives which seek to enhance care coordination
introducing information technologies. The design process seeks to accommodate
input from interdisciplinary teams attempting to improve patient
care (Nelson & Staggers, 2014).
System Enhancement
CDS systems are currently faced with various implementation challenges and lack the
full range of capabilities, which it could potentially achieve.
The most significant required enhancement, based on conducted studies and
feedback, is an improvement of system usability. At first, that requires
introducing relevant guidelines and training for health practitioners using the
system. Furthermore, the system design should be interactive and
intuitive, based on a familiar operating system. Usability can also apply to the
physical device on which the CDS system is installed, availability of
options for information input, and its effectiveness over time (Thum et al.,
2014).
Conclusion
Overall, the CDS system is a viable introduction to medical organizations, which
significantly assists with clinical workflow efficiency and healthcare
costs. Using this type of information technology, nurses can improve the quality
of patient care through a variety of factors. Nurse effectiveness
improves as the system can eliminate redundant processes, rapidly provide
information, and reduce human error. Patients experience a higher quality
of care through evidence-based practice, which aids with disease management,
therefore reducing repeated hospitalizations and length of stay, which,
in turn, drives down out of pocket costs.
-------------
INTRO
-------------
Clinical decision support systems are computer application clinicians interact with
them in decision making and help them at the point of care.
They interact with the clinician to determine diagnosis based on patient data or
analysis of patient data. In addition, they link physician clinical
observation with health knowledge to practice safe, quality health care. They vary
depending on the complexity and desired function or application
(Payne, 2000).
Clinical decision support systems (CDSS) are computer-based programs that analyse
data within EHRs to provide prompts and reminders to assist health care providers
in implementing evidence-based clinical guidelines at the point of care. This helps
in reducing medical errors by providing rich relevant clinical information. We
should understand the importance of Evidence-Based Medicine. It allows doctors to
prepare and review a diagnosis through an integrated solution that provides clear,
consistent information to provide a better patient outcome. Integration of CDSS not
only helps in inpatient care, but also helps a clinician to take an informed
medical decision for an outpatient care. A clinician from a hospital in remote
areas, who not necessarily has a large team, is limited to his own experience and
knowledge while treating a patient. It is in such cases that CDSS tools can help
them make sound medical decisions to ensure better outcomes. Similarly, a clinician
working with a team for inpatient care, CDSS enables them in providing a
personalized care and at the same time, keeps a check on the patient’s course of
treatment through its alerts system. Hence, with CDSS, every piece of information
is accessible at just a click.
-----------------------------------------------------------------------------------
-----------
Purpose of clinical decision system in the delivery of health care
-----------------------------------------------------------------------------------
------------
In today’s health care, the goal for clinical decision support in the delivery of
health strive to provide information to the right person, with the
appropriate format, through the right channel and at the right point in clinical
work flow to improve health and healthcare decision and outcome
(Osheroff et al., 2006). The intervention aim to:
1. Delivery of quality evidence – based medical principals for diagnostic and
disease management guidelines.
2. Alert for potential clinical safety and quality problem during the care of the
patient and help prevent them.
3. Training and regulate clinician to updated information for the best clinical
practice.
4. Improve the cash flow and operating margins.
Programs like internist 1, Dxplain and quick medical reference are functional
computer application tools assists in diagnosis. Clinicians input clinical
values like historical and physical examination findings, laboratory and test
results and based on the data, the computer application, provides
differential diagnosis. After the diagnosis, other clinical application tools can
be used to improve the diagnosis and patient outcome. For example,
the management of community acquired pneumonia, clinician inputs required data of
the patient then the clinical decision application tool would
provide a recommendation on how to progress outpatient therapy decreasing the
likelihood of medical errors (Marrie et al., 2000). This tool can be
also used in the situation where a clinician is not sure or symptom seem confusing
or complex and this save time for the clinician to act and document
and comply with guidelines (Payne, 2000).
Patient alert-monitoring devices provide real time changes of patient condition,
Warning and alert signal clinical staff for intervention.
On the other hand, alerts and reminders provide tasks lists for clinicians, such
as post-op checks for the purpose to assist in order entry.
Application tool access different drug databases in different clinical setting
system like laboratory, pharmacy and hospital system and it checks
transcription errors and provide feedback to the clinician inputting the order on
drugs compatibility and interaction, drug sensitivity, allergy and
possible duplication in real time (Alliance for Health Reform,2006).
Clinicians have the standards mandated by their practicing or clinical setting to
perform a procedure, intervention based on patient or clinical data.
Reminders and prompts applied before or during patient interaction with physician
can aide physician decide the appropriate step for therapy.
They have effectively proven in increasing preventive care standard and
prescribing. Therefore, clinician uses prompt and reminders in clinical
decision support system for the purpose to improve clinical effectiveness. Patient
based prompts contact patient by texting messages, emailing or
voice. They are specific to obtain optimized results (Krall & Sittig, 2002).
Lastly, the clinical decision applications tool integrates financial and clinical
information to improve clinical performance as well control the cost.
Benefits computerized provider order entry (CPOE) and electronic prescribing
Provider order entry (CPOE) is a computer application tool of processing clinician
orders for the client or patient care in the health care information
system (Hebda & Czar, 2009). On the other hand, electronic prescribing (e-
prescribing) refers to transmission of electronic drug prescription from the
provider ordering system the pharmacy system near the client or preferred client
pharmacy (Blair, 2006).
Many CPOE applications have access to evidence based clinical guidelines and
interact with clinician with the aim for CPOE to reduce transcription and
medication errors, decrease time for the time drug ordered to time drug dispensed,
more ordering standards and completeness of the orders, and incorporation of alerts
to warn potential drug dosage problem or critical lab value. In addition to
allergy, drug interaction and contraindications such as during pregnancy and other
health issues (Hebda & Czar, 2009). Medication error leads to adverse drug
reaction, the largest cause of extended length of stay in the hospital before CPOE
innovation (Sengstack & Gugerty, 2004).
Likewise, electronic prescribing reduces medication errors and provides
understandable information to pharmacists from CPOE information system. This is one
of the key plans to enable adoption of Electronic Medical Record to a national
electronic health infrastructure in America (Centers for Medicare and Medicaid
Services, 2009). E -Prescribing has improved patient outcome due to new tools
deployed to the system – drug-experience outcomes to provide the clinician feedback
of the drug. This is a breakthrough to electronic patient quality of care (Schiff &
Bates, 2000).
----------------------------------------------------------------------
Functions of Clinical Decision Support System
------------------------------------------------------------------------
There are 4 basic functions contain in Clinical Decision Support System which are
Administrative, Managing clinical complexity and details, Cost control, Decision
support by based on Perreault & Metzger.
Administrative means system must be administrable which means that it must be able
to support clinical coding and documentation, procedures and referrals of the
medical center. In order to achieve that, CDSS is always created through multiple
platforms and it understands very well on every medical’s standard procedure.
Other than that, it must be able to manage clinical complexity and details. It
keeps patients on research and chemotherapy protocols as clinical experts always
did. It tracks patient orders, referrals follow-up the status of patient and
preventive care after prescription.
Cost controllable by avoiding any duplication of process, document or any
unnecessary lab test and to monitor medication orders to confirm any incorrect
places which might be a direct harm to particular medical center’s financial
Decision Support is mean to support clinical diagnosis and treatment plan processes
and promoting use of best practices, condition-specific guidelines, and population-
based management.
------------------------------------
Characteristics of CDSS
------------------------------------
There are 4 basic component usually required by CDSS which are Inference Engine,
Knowledge Base, Explanation Module and Working Memory.
Inference Engine
Inference Engine is the main part of CDSS. It used knowledge from database
integrated with the system as well as the knowledge about the patient to generate
an output or a conclusion based on certain condition. Inference engine control the
actions of the system and guide system with the best actions. For an example, it
will start to detect the condition to trigger the alert or conclusion to be
displayed in a diagnostic progress.
Knowledge Base
Knowledge Base acquired the knowledge Inference Engine used to present to the
users. In Knowledge base, it contains every risk factor to carry out in new lesions
and risk scores. It will be built with the involvement of clinical domain experts
with also every activity of create, edit and maintenance. In another way, some
knowledge base is created through automated process. Automated process knowledge is
acquired from external sources such as books, magazine, journal articles and
database by a computer application. The process of creating a knowledge base is
complex and complicated. In order to make it easier, there are tools specially
created to facilitate the acquisition and elicitation of knowledge base. There is
an example tool called Protégé, a knowledge- based development environment.
Working memory
Working memory is a collection of patient data or form of a message which is stored
inside database. These data may include patient’s age, name, data of birth, gender
and etc or allergies, history medical information or problems and other
information.
Explanation Module
Explanation Module responsible in composing justification for the conclusions drawn
by the Inference Engine by applied Knowledge base and patient data. This component
is not presented in all CDSSs.
In another way, CDSS can work on synchronous mode and asynchronous mode. In
synchronous mode, users can communicate directly with application to wait for the
output from system. Users will have to wait for the output in order to continue
their works. For example, CDSS checks for drugs interaction or any possible
medicine that patient allergies to then clinician will only able to continue to
diagnose patient by based on the result generated by CDSS. When there is in
asynchronous mode, CDSS is performing independently while does not required user to
wait for. For an example generate a checkup reminder for patients.
CDSS: The way forward
There has always been an innate hesitancy towards adopting digital tools like
CDSS, given the limited knowledge and awareness amongst people. However today, the
online world has expanded tremendously, something that reflects in the healthcare
space, with increased usage of digital prescriptions. As far as the scientific
progression goes, along with the unique morbidity in each patient, no two patients
can be looked at from the same lens. Therefore, such systems enable doctors to
understand various drug interactions and providing an evidence-based course of
treatment. CDSS helps in screening the right amount of data with updated guidelines
while the clinician is on the move, providing an easy accessibility to the
information. This makes CDSS to be one of the most sought digital tools in today’s
time.
Delving deeper into Covid complications
A few months ago, ‘Mucormycosis’ was the most debated term as a post-COVID
complication, followed by secondary complications due to dengue. Other lasting
health effects included long-term breathing problems, heart complications, chronic
kidney impairment, pulmonary embolism, and stroke. Patients experiencing common
symptoms like fatigue, lethargy, lack of taste, lack of smell, anxiety, to rare
complications like Guillain-Barre syndrome (temporary paralysis), and multisystem
inflammatory syndrome in children were also evident. Further, Infections like CMV
(Cytomegalovirus), Aspergillus were also traced in patients due to immune
suppression/ immune modulation most likely due to steroids or other
immunomodulatory drugs, that were used during COVID treatment.
