Evidence-based medicine; Clinical

decision support systems

LIS 4785 Introduction to Health Informatics

Fall 2015, Week 8-2
Instructor: Dr. Sanghee Oh
 Show and Tell

• Winston Jones
 Evidence-based Medicine
• Evidence-based medicine (EBM) is the process of systematically
reviewing, appraising and using clinical research findings to aid
the delivery of optimum clinical care to patients.
• “The conscientious, explicit and judicious use of current best
evidence in making decisions about the care of individual
patients” (Sackett et al., 1996).
• The practice of EBM is the integration of individual clinical
expertise with the best available external clinical evidence from
systematic research (Sackett et al., 1996).
CLINICAL DECISION SUPPORT
SYSTEM (CDSS)
 VisualDx

https://www.youtube.com/watch?
v=j8fCpEaiGA4

https://www.youtube.com/watch?v=j8fCpEaiGA4
 Clinical Decision Support System (CDSS)
• Computer software that presents uses with
________________________________________________ to
enhance healthcare provision and management
• Providing ______________________________________with
knowledge and person-specific information, intelligently filtered
or presented at appropriate times, to enhance health and health
care.
• Clinical decision making is based on ___________________,
which is derived from closed clinical trials and sound statistical
analysis.
 CDSS Components
• Encompassing a variety of tools to
enhance decision-making in the clinical
workflow. These tools include:
– computerized alerts and reminders to
care providers and patients
– clinical guidelines
– condition-specific order sets
– focused patient data reports and
summaries
– documentation templates
– diagnostic support
– contextually relevant reference
information among other tools.
 Benefits of CDSS
• CDSS has a number of important benefits, including:
– Increased quality of care and enhanced health outcomes
– Avoidance of errors and adverse events
– Improved efficiency, cost-benefit, and provider and patient
satisfaction
 CDSS and Patient Care

• ________________________:
– Communicating with patients; showing empathy and
compassion; and being willing to consider the social and
psychological factors that could affect a patient’s illness,
diagnosis, and treatment.

• Micro vs. Macro

 CDSS in the Micro Process
• The decision process that a physician and
her staff face during
_________________________________.
• This process might involve _______
encounter, characterized by a persona
becoming ill, visiting a physician, receiving
treatment, getting well, and leaving the
system
• CDSS offer _________________________at
the point of clinical encounter, and that
evidence is generated by seasoned
researchers in respected health centers.
– Standardization & formalization
• CDSS can bring accumulated scientific and
experiential knowledge, including collegial
consultation, to the point of clinical decision
making
 CDSS in the Macro Process
• The clinical decision process for
_______________________________
from numerous physicians and other
health professionals who are associated
with different healthcare organizations
• HIT supports integrating, coordinating
clinical activities over time, geographic
space (territory), and professional
domains (technology).
• Health organization and professionals can
structure clinical decision-making process
around patients, transcending individual
professionals and organizations to
provide continuity and avoid duplication
and gaps
 VisualDx Tutorial 01: Basic Search

https://www.youtube.com/watch?v=_7QutSqddSA
 CDSS & EHR
• Different types of CDSS may be ideal for __________________ of
care in different settings.
• The majority of CDSS applications operate as
_________________, although _____________________ are also
used.
 CDSS & EHR
• EHRs, e-prescribing systems, computerized physician order entry, and
medication reconciliation systems all are strengthened by some form of
clinical decision support.

• CDSS should be implemented to an EHR system in order to achieve

Meaningful Use Stage 1.

• CDSS has been a requirement measure to achieve Meaningful Use State 2

for the improvement of performance on high-priority health conditions.

• The resource specification is available from here:

– Stage 1: http://
www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePr
ograms/downloads/11_Clinical_Decision_Support_Rule.pdf

– Stage 2: http://
www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePr
ograms/downloads/Stage2_EPCore_6_ClinicalDecisionSupport.pdf
 CMS Meaningful Use Regulations
• An effort lead by CMS
(Centers for Medicare
& Medicaid Services)

• CMS: Previously known

as the Health Care
Financing
Administration (HCFA),
is a federal agency
within the United
States Department of
Health and Human
Services (DHHS)
 Meaningful Use: 13 Core Objectives

1. Computerized provider order entry (CPOE)

2. Drug-drug and drug-allergy checks
3. Maintain an up-to-date problem list of current and active diagnoses
4. E-Prescribing (eRx)
5. Maintain active medication list
6. Maintain active medication allergy list
7. Record demographics
8. Record and chart changes in vital signs
9. Record smoking status for patients 13 years or older
10. Implement clinical decision support
11. Provide patients with the ability to view, download, or transmit
their health information online
12. Provide clinical summaries for patients for each office visit
13. Protect electronic health information
CLINICAL PRACTICE GUIDELINES
 Clinical Practice Guidelines (CPGs)
• _________________________ to
assist practitioners and patient
decisions about health care for
specific clinical circumstances
• The very best evidence based
medical information and formulate
an approach to treat a specific
disease or condition.
• CPGs represent ______________
in which evidence is transformed
into a recommendation at the
point of care.
• Many medical organizations use
CPGs with the intent to improve
quality of care, patient safety and
or reduce costs.
CPG Example: Post-Traumatic Stress Disorder
(PTSD) Evaluation
 Barriers to CPGs

• Practice setting
• Contrary opinions
• ________________
• ________________, impractical or confusing
• No uniform level of evidence rating system
• ____________________
• Excessive influence by drug companies
• Quality
• _________________
Ambulance Tasmania - Clinical Practice
Guidelines
 Web-based CPGs

• National Guideline Clearing House, offered by AHQA, U.S. DHHS

• National Institute for Health and Clinical Excellence (NICE)
• Agency for Health Care Research and Quality (AHRQ)
• Institute for Clinical System Improvement (ICSI)
 Setting Standards for Trustworthy CPGs
• Establishing transparency;
• Management of conflict of interest;
• Guideline development group
composition;
• Clinical practice guideline–systematic
review intersection;
• Establishing evidence foundations for
and rating strength of
recommendations;
• Articulation of recommendations;
• External review; and http://
iom.nationalacademies.org/Reports/2011/Clinic
• Updating. al-Practice-Guidelines-We-Can-Trust.aspx

• By IOM, 2011