Comp6 Unit5b Lecture Slides

Health Management Information
Systems
Clinical Decision Support Systems
Lecture b
This material Comp6_Unit5b was developed by Duke University, funded by the Department of Health and Human Services,
Office of the National Coordinator for Health Information Technology under Award Number IU24OC000024.
(CDSS)
Learning Objectives
1. Describe the history and evolution of clinical
decision support (Lecture a)
2. Describe the fundamental requirements of
effective clinical decision support systems
(Lecture a)
3. Discuss how clinical practice guidelines and
evidence-based practice affect clinical decision
support systems (Lecture a)

2
Health IT Workforce Curriculum
Version 3.0/Spring 2012
Health Management Information Systems
Lecture b
(CDSS)
Learning Objectives
4. Identify the challenges and barriers to building
and using clinical decision support systems
(Lecture b)
5. Discuss legal and regulatory considerations
related to the distribution of clinical decision
support systems (Lecture b)
6. Describe current initiatives that will impact the
future and effectiveness of clinical decision
support systems (Lecture b)

3
Lecture b
CDSS Challenges
Achievement of the five rights of clinical decision
support requires communicating the
Right information
To the right person
In the right format
Through the right channel
At the right time

4
Lecture b
Challenges in Designing or
Selecting CDSS
Whose decisions are being supported?
What information is presented?
When is the information being presented?
How is the information being presented?

5
Lecture b
User Control
User presentation
Automatically
On demand
User reaction

6
Lecture b
CDS Intent and Key Issues
CDS Intent Match to Users
Intention
Key Issues
Reminder of actions user
intends to do, but should
not have to remember
(automatic)
High Timing
Provide information when
user is unsure what to do
(on demand)
High Speed and ease of access
Correct users errors
and/or recommend user
change plans (automatic
or on demand)
Low Automatic: timing,
autonomy and user control
over response
On demand: speed, ease
of access, autonomy and
user control over response
Table 5.1 CDS Intent and Key Issues

(Berner, 2009)

7
Lecture b
Challenges in Building CDSS
Impact on Care Process and Patient Health
Outcomes
Match of CDS to user intentions
User control, disruptiveness, and risk
Integration of CDS into work processes
Impact on structure
Impact on resources
8
Lecture b
Barriers to Using CDSS
Acquisition and validation of patient data
Modeling of medical knowledge
Elicitation of medical knowledge
9
Lecture b
Barriers to Using CDSS
Representation of and reasoning about medical
knowledge
Validation of system performance
Integration of decision-support tools

10
Lecture b
Legal Barriers
Lack of detailed case laws for CDSS
Which category of law
Negligence law
Product liability law
11
Lecture b
Legal Barriers
Liability borne by
Physicians
Developers of systems

12
Lecture b
Regulatory Barriers
Prerelease regulations of medical software
Data privacy and security
13
Lecture b
Legislative and Regulatory Efforts
Drive measurable progress toward priority
performance goals for health care quality
improvement through effective use of CDS
Explore options to establish or leverage a public-
private entity to facilitate collaboration
Accelerate CDS development and adoption
though federal government programs and
collaborations
14
Lecture b
Future Directions for CDSS
ONC initiatives
IOM studies
Meaningful use objectives and measures

15
Lecture b
ONC Initiatives
Major activities
Advancing CDS
Development of a Roadmap for National
Action on Clinical Decision Support
AHIC CDS Work Group recommendations
Clinical Decision Support (CDS) Workshop
CDS Federal Collaboratory
IOM study
16
Lecture b
IOM Studies
1999 IOM study
To improve safety, health IT systems should
be designed to make it easy to do the right
thing.
2011 IOM study
Recommend ways to make patient care safer
using health IT
17
Lecture b
Stage 1 Meaningful Use
ARRA
HITECH Programs
Regulations
Meaningful use of interoperable health information
technology and qualified EHRs
Eligible Professional
Hospital

18
Lecture b
Summary

Definition
System requirements
Affects of clinical practice guidelines and
evidence-based practice on CDSS
Challenges and barriers
Legal and regulatory barriers
Future directions for clinical decision support
systems
19
Lecture b
References Lecture a
References
Berner, E. S. (2009, June). Clinical decision support systems: State of the Art. AHRQ Publication No. 09-0069-EF.
Rockville, Maryland: Agency for Healthcare Research and Quality
http://healthit.ahrq.gov/images/jun09cdsreview/09_0069_ef.html
AHIC. (2008, April 22). CDS recommendations, Retrieved from
http://www.hhs.gov/healthit/documents/m20080422/6.2_cds_recs.html
Centers for Medicare and Medicaid Services. (2011, November 7). EHR incentive programs overview. Retrieved
from https://www.cms.gov/ehrincentiveprograms/#BOOKMARK1
Centers for Medicare and Medicaid Services; Medicare and Medicaid Programs; Electronic Health Record
Incentive Program; Final Rule, 42 CFR Parts 412, 413, 422 et al. (July 28, 2010). Retrieved from
http://edocket.access.gpo.gov/2010/pdf/2010-17207.pdf
Institute of Medicine. (2012). Health IT and patient safety: Building safer systems for better care. Washington , DC:
The National Academies Press.
Musen, M. A., Shahar, Y., & Shortliffe, E. H., (2006). Clinical decision-support systems. In Shortliffe. E. H., &
Cimino, J. J. (Eds.), Biomedical informatics: Computer applications in health care and biomedicine (3
rd
ed) (pp.
698-736). New York, NY: Springer Science + Business Media.
National Academy of Sciences. (2011, November). Report brief. Retrieved from
http://iom.edu/~/media/Files/Report%20Files/2011/Health-IT/HealthITandPatientSafetyreportbrieffinal_new.pdf
National Academy of Sciences. (2000). Report brief. Retrieved from
http://iom.edu/~/media/Files/Report%20Files/1999/To-Err-is-
Human/To%20Err%20is%20Human%201999%20%20report%20brief.pdf

20
Lecture b
References Lecture a
References
Office of the National Coordinator for Health Information Technology. (2011). CDS activities. Retrieved from
http://healthit.hhs.gov/portal/server.pt/community/healthit_hhs_gov__cds_activities/3787
Osheroff, J. A., Teich, J. M., Middleton, B. F., Steen, E. B., Wright, A., & Detmer, D. E. (2006, June 13). A roadmap
for national action on clinical decision support (ONC Contract HHSP233200500877P). Retrieved from AMIA
website: http://www.amia.org/sites/amia.org/files/A-Roadmap-for-National-Action-on-Clinical-Decision-Support-
June132006.pdf
Sirajuddin, A. M., Osheroff, J. A., Sittig, D. F., Chuo, J., Velasco, F. & Collins, D. A. (2009, Fall). Implementation
pearls from a new guidebook on improving medication use and outcomes with clinical decision support. Journal of
Healthcare Information Management. 23(4), 38-45.
U.S. Department of Health and Human Services. (2010, September 29). Institute of Medicine will study best
policies and practices for improving health care safety with health information technology. Retrieved from
http://www.hhs.gov/news/press/2010pres/09/20100929b.html

Table
5.1 Table: Berner, E. S. (2009, June). Clinical decision support systems: State of the Art. AHRQ Publication No. 09-
0069-EF. Rockville, Maryland: Agency for Healthcare Research and Quality
http://healthit.ahrq.gov/images/jun09cdsreview/09_0069_ef.html

21
Lecture b

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