in Medical Journals, visit www.icmje.org. In earlier days, this whole process could take place in the brain of the practitioner. Ann Intern Med 2006;144:742â752. Effect of clinical decision-support systems: a systematic review. Methods: A systematic review of peer-reviewed studies was performed to evaluate clinically relevant outcomes related to the use of CDS tools for the diagnosis, treatment, and supportive care of patients with cancer. Overview Full Text Ottawa: National Steering Committee on Patient Safety, 2002. HealthIT.gov website. Internist-1, an experimental computer-based diagnostic consultant for general internal medicine. HealthPartners Institute is an Affiliate Member of the HCS Research Network. The effectiveness of computerized clinical guidelines in the process of care: a systematic review. The types of CDSS available are as broad as human ingenuity allows: from personal digital assistant applications customized by a single clinician to multihospital mainframe-based surveillance systems meant to assure care for thousands of patients. Acquisition and assembly of data: Pawloski, Olson-Bullis. This model often does not express knowledge very well since it simply infers disease from the presence of certain symptoms. The result, a low potassium of 2.9 mmol/L, is entered into the laboratory information system. Titles and abstracts were excluded based on mutual agreement; those not mutually determined to be included or excluded were adjudicated by the third investigator. N Engl J Med 1980;303:192-197. Int J Radiat Oncol Biol Phys 2012;83:1246â1251. Int J Med Inform 2013;82:504â513. The Arden Syntax is a quasi-programming language that allows the encoding of decision rules into a computer-readable format. The areas addressed may include foundations, functionality, interfaces, implementation, impacts, and evaluation of decision support systems (DSSs). Ann Oncol 2015;26:981â986. Studies of decision aids intended primarily for patient use were excluded. de Lusignan S, Chan T. The development of primary care information technology in the United Kingdom. Clinical decision support systems for improving diagnostic accuracy and achieving precision medicine. Dr Pusic is assistant professor, Department of Pediatrics, UBC, and research director, Division of Emergency Medicine, Children’s and Women’s Health Centre of BC. Huertas FernÃ¡ndez MJ, Baena-CaÃ±ada JM, MartÃnez Bautista MJ, . The costs of system maintenance, upgrades, or enhancements were also not described. An important finding that is absent will downgrade the diagnosis within the differential diagnosis. Published studies of CDS systems are largely associated with positive outcomes, and their findings consistent with those of studies conducted in the noncancer population. With evidence supporting the effectiveness of all these systems, it is important to plan for decision support when designing and installing modern health information systems. A clinical decision support system is one of the key components for reaching compliance for Meaningful Use. Adeboyeje G, Agiro A, Malin J, . 5 In the report, the agency described clinical decision support as technology that “provides healthcare providers and patients with knowledge and person-specific information, intelligently filtered or presented at … 11. The EBMeDS system is the computerized clinical decision support (CCDS) system of EBPNet, a national computerized point-of-care information service in Belgium. This multicenter retrospective study sought to determine clinimetric performance of a cloud-based computerized sepsis clinical decision support system (CDS), understand the epidemiology of sepsis, and identify opportunities for quality improvement. Computerized physician order entry (CPOE) is another technology that enables the presentation of tailored knowledge or information at the time of a clinical decision. One study evaluated prescriber alerts with CDS tools and demonstrated that hard stops for hepatitis B screening before chemotherapy treatment were associated with increased screening (99.3% vs 40.2%; PP43. Likewise, HIT targeting behavioral change is less likely to be beneficial compared with HIT targeting improved decision-making. Full PubMed search parameters are available in supplemental eAppendix 1 (available with this article at JNCCN.org). While in experimental tests the system could be as good as a panel of clinicians, MYCIN was never widely used because of difficulties with maintenance and incorporating the system into a clinician’s workflow. The complexity of diagnosis and treatment, the volume of information needed, and the factors associated with behavior change were given as potential reasons for these findings. Harris AD, McGregor JC, Perencevich EN, . Cho E, Kim HJ, Kim GM, . PubMed Abstract Handbook of Medical Informatics. Reduction in chemotherapy order errors with computerized physician order entry. A large part of any physician’s work, especially in non-procedural disciplines, involves acquiring information and then, aided by evidence and experience, making decisions for the best possible outcome. Castaneda C, Nalley K, Mannion C, . Hanauer DA, Zheng K, Commiskey EL, . Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Clinical Decision Support Systems: State of the Art. 2004 , Dr J. Tarver WL, Menachemi N. The impact of health information technology on cancer care across the continuum: a systematic review and meta-analysis.  The authors found that clinician or patient compliance with evidence-based recommendations improved only a modest amount: from 52% without to 57% with a system. Patient 2015;8:397â409. Int J Qual Health Care 2013;25:656â663. PubMed Abstract Full Text 9, 10 Several such systems have been implemented for asthma management, 11–16 but overall results have been mixed. Am J Prev Med 2011;40(5 Suppl 2):S198â207. None of the studies assessed the impact of CDS systems on patient survival. Seven of eight relevant systematic reviews found a positive effect on provider or patient behavior. Prevention of acute exacerbation of chronic hepatitis B infection in cancer patients receiving chemotherapy in a hepatitis B virus endemic area. Moher D, Liberati A, Tetzlaff J, . Int J Qual Health Care 2011;23:36â43. Clinical decision support systems. Effects of computerized clinical decision support systems on practitioner performance and patient outcomes: a systematic review. Berner ES. New York: Springer-Verlag, 2001:573-609. Clinical decision support (CDS) systems are a necessary component that assist healthcare organisations to reach enhanced digital maturity, by enabling clinicians to provide evidence-based care for improved patient outcomes and reduced treatment costs. Clinical decision support systems use specific para… (eds). Only the first three authors are listed, followed by "et al.". BCMJ standard citation style is a slight modification of the ICMJE/NLM style, as follows: For more information on the ICMJE Recommendations for the Conduct, Reporting, Editing, and Publication of Scholarly Work Keywords:Clinical decision support system, fuzzy logic, diabetic nephropathy, hemodialysis, risk assessment, cardiovascular diseases. Enabling health care decisionmaking through clinical decision support and knowledge management. to save searches and organize your favorite content. Accessed March 13, 2018. performed a comprehensive search of the literature to identify studies meeting the inclusion criteria. J Am Med Inform Assoc. In this paper, we investigate the performance of a clinical decision-support system (CDSS) that had been previously built and validated internally. J Am Med Inform Assoc 2011;18:789â798. J Oncol Pharm Pract 2008;14:181â187. A recent review of 57 randomized controlled trials and 10 systematic reviews evaluated the effectiveness of computer-based delivery of health evidence, including CDSS. In a manner consistent with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement, we conducted a comprehensive review of the clinical and scientific literature.19 A trained health sciences librarian (B.A.O.B.) In PubMed, the MeSH terms defined the concepts of cancer and CDS systems, medical order entry systems, or clinical pathways. Washington, DC: National Academy Press, 1999. The first article on this subject appeared in the scientific literature about 60 years ago, 1 and the notion of computer-based clinical decision support has subsequently been a dominant topic for informatics research. However, the labor-intensive, often biased process of entering findings limits its utility. The question is surprisingly hard to answer. Heidelberg: Springer-Verlag, 1997:261-276. Clin Transl Oncol 2006;8:821â825.  These applications judiciously deliver information or knowledge that can beneficially alter clinical decision making. Systematic review: impact of health information technology on quality, efficiency, and costs of medical care. Chen AR, Lehmann CU.  The program takes historical and physical findings and generates a differential diagnosis. Background: Clinical decision support systems (CDSSs) are an integral component of today’s health information technologies. The domain of discourse is dermatology, in particular the diagnosis of pigmented skin lesions. Research that identifies CDSS methods that alert health care providers to errors has become a critical element in improving patient safety. A broad range of information systems can now generate patient-specific advice to aid clinical decision making. Clinical decision support systems (CDSSs) have been hailed for their potential to reduce medical errors1 and increase health care quality and efficiency.2At the same time, evidence-based medicine has been widely promoted as a means of improving clinical outcomes, where evidence-based medicine refers to the practice of medicine based on the best available scientific evidence. Data analysis and interpretation: Pawloski, Brooks, Nielsen. Included studies assessed â¥1 of the following: clinical outcomes (including patient-reported outcomes [PROs]), costs, and care delivery process measures (eg, medication prescribing error rates or compliance with clinical practice guidelines [CPGs]).  The two most famous examples are the MYCIN and QMR systems. Effect of computerisation on the quality and safety of chemotherapy prescription. Available at: https://joinup.ec.europa.eu/sites/default/files/document/2014-12/eHealth%20for%20a%20Healthier%20Europe%20-%20Opportunities%20for%20a%20better%20use%20of%20healthcare%20resources.pdf. J Am Med Inform Assoc 2003;10:154-165. 1. van der Lei J. Maviglia SM, Zielstorff RD, Paterno M, et al. eHealth for a Healthier Europe! of Medical Journal Editors (ICMJE) recommends the following citation style, which is the now nearly universally Pain 2009;147:20â28. Electronic database searches yielded 2,439 potentially eligible papers (Figure 1). However, little is known regarding the use of CDS systems in clinical oncology and their impact on patient outcomes. It is crucial that clinicians be involved in the development and rigorous scientific evaluation of these systems. Basch E, Deal AM, Kris MG, . Computer-assisted decision support in medical oncology: we need it now. Provision of study materials: Olson-Bullis. PubMed Abstract Full Text The differences in health outcomes between Web-based and paper-based implementation of a clinical pathway for radical nephrectomy. Potential drawbacks may be the need to access separate systems and increased workflow for prescribers or other clinicians. , CDSS may have even more potential in applications that deliver unsolicited advice. There is a critical need for CDS systems development and well-designed studies to demonstrate improvement in patient outcomes, including impact on survival and efficiency of cancer care delivery. Diabetes systems might be the best example of cases where patient-specific data, such as blood glucose measurements and food intake, are used to generate customized educational modules and detailed dietary recommendations. 9. Features of effective computerised clinical decision support systems: meta-regression of 162 randomised trials. 17, 18 While some studies have reported improvements in documentation, 13 processes, 11, 15 or outcomes, 14 others … Clinical decision support systems. To Err Is Human: Building a Safer Health System. However, one study in our analysis showed that there was an increase in pharmacist order review time without any impact on intervention rates.21 This finding underlines the potential for CDS systems to have a negative impact on care delivery, and demonstrates the importance of a thorough evaluation of these tools as a part of system implementation. Arch Intern Med 2003;163:1409â1416. Effects of computer-based clinical decision support systems on physician performance and patient outcomes: a systematic review. BJU Int 2002;90:522â528. Using computerized decision support to improve compliance of cancer multidisciplinary meetings with evidence-based guidance. To date, few studies have evaluated CDS systems in oncology practice. 13. J Ambul Care Manage 2008;31:201â210. J Am Med Inform Assoc 1997;4:S20-S30. , The QMR system uses an ingenious algorithm modeled on the clinical reasoning of a single University of Pittsburgh internist. The systems used are usually referred to as clinical decision support systems or CDSS. BMJ Open 2012;2:2. Hsu PI, Lai KH, Cheng JS, . Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement, Reduction in chemotherapy order errors with computerised physician order entry and clinical decision support systems. The promised benefits of health information technology rest in large part on the ability of these systems to use patient-specific data to provide personalized recommendations for care. Clinical decision support (CDS) systems include any electronic system designed to directly aid clinical decision-making by using individual patient characteristics to generate patient-specific assessments or recommendations. A major gap in CDS system use exists across the spectrum of clinical oncology care, and further development of CDS tools is warranted. Clinical Decision Support Systems: State of the Art. Washington, DC: The National Academies Press; 2013. In: Shortliffe EH, Perrault L, Wiederhold G, et al. Most studies were conducted at a single facility (79%), 87% used quasi-experimental designs, and only 13% (n=3) were randomized controlled trials. 14. vol. Reflecting these concerns, in 2014 the Centers for Medicare and Medicaid (CMS) announced that, in order to be reimbursed by Medicare, high-cost images will have to be ordered through a Clinical Decision Support (CDS) system that meets specific Appropriate Use Criteria (AUC). The development of clinical decision support systems (CDSSs) for the diagnosis of primary headaches has long been a major research topic. We urge clinicians to identify opportunities for CDSS and to advocate within their health care settings for the development of systems that bring about meaningful improvement of health outcomes. Doolan DF, Bates DW, James BC. Is living near power lines bad for our health? Currently, <15 studies assessing the impact of CDS systems are underway or accruing, according to ClinicalTrials.gov.49 A recent study of CDS in patients with lung cancer showed a reduction in inappropriate granulocyte colony-stimulating factor use without an increase in febrile neutropenia rates, illustrating the positive impact these powerful tools can have on clinical oncology care.50 Further analyses of the use of these tools with appropriate study designs and analytic methods are necessary to build the case for wider implementation of CDS systems. Evid Rep Technol Assess (Full Rep) 2012;203:1â784. JAMA 1999;282:1851-1856. Assessment of efficiency and safety of the comprehensive Chemotherapy Assistance Program for ordering oncology medications. We performed a systematic review of peer-reviewed, English-language studies published between January 1, 1995, and December 31, 2016, that evaluated the implementation of an electronic CDS system in the field of cancer care. patients. The BC Medical Journal is a general medical journal published by Doctors of BC. A working definition has been proposed by Robert Hayward of the Centre for Health Evidence: "Clinical decision support systems link health observations with health … Available at: https://www.healthit.gov/policy-researchers-implementers/clinical-decision-support-cds. From: Infectious Diseases (Fourth Edition), 2017 CDS tools have been incorporated across the patient care spectrum, encompassing prevention, diagnosis, and clinical monitoring. Full-text articles were retrieved and reviewed when additional information was needed. Available at: https://clinicaltrials.gov/ct2/home. The studies did not specify the potential challenges facilities may encounter when implementing similar systems or describe identified best practices to support successful implementation or outcomes. The primary findings show that the beneficial impact differed across the cancer continuum; HIT for diagnosis and treatment was less likely to be associated with benefit compared with prevention. Clinical Decision Support Systems (CDSS) provide aid in clinical decision making and therefore need to take into consideration human, data interactions, and cognitive functions of clinical decision makers. Blois MS. Clinical judgment and computers. J Clin Oncol 2011;29:1029â1035. Bibliographies from selected key articles, relevant review articles, and related meta-analyses were reviewed to identify additional publications. Clinical Decision Support Systems (CDSS) are considered essential tools of evidence-based medicine. The group became known as the Health care organizations are turning to electronic clinical decision support systems (CDSSs) to increase quality of patient care and promote a safer environment. PLoS Med 2009;6:e1000097. Abstract Full Text For optimal retrieval, all terms were supplemented with relevant title and text words. Chang Gung Med J 2008;31:567â575. Kawamoto K, Houlihan CA, Balas EA, . Clearly, to exploit the opportunities for these types of clinical decision support interventions, we must have effective health information systems in place.