DNP 805 Topic 3 Discussion Question Two
DNP 805 Topic 3 Discussion Question Two
Select a particular medication or clinical problem. Describe how the CPOE and/or CDSS technologies support care decisions in this area.
Clinical decision support includes a variety of tools and interventions, computerized as well as non- computerized. Non-computerized tools include clinical guidelines or digital clinical decision support resources like ClinicalKey® or UpToDate ® [1, 2]. Such clinical decision support systems (CDSS) are characterized as tools for information management. Another category of CDSS sometimes also called basic or simple clinical decision support systems are tools to help focus attention. Examples of such CDSS include laboratory information systems (LISs) highlighting critical care values or pharmacy information systems (PISs) presenting an alert ordering a new drug and proposing a possible drug-drug interaction [3, 4]. Most focus in the past few decades however has gone to tools to provide patient-specific recommendations called advanced CDSS. Advanced CDSS mayinclude, for example, checking drug disease interactions, individualized dosing support during renal impairment, or recommendations on laboratory testing during drug use.
11.1.2. Why CDSS?
The quantity and quality of clinical data are rapidly expanding, including electronic health records (EHRs), disease registries, patient surveys and information exchanges. Big data and digitalization however, does not automatically mean better patient care. Several studies have shown that only implementing an EHRand computerized physician order entry (CPOE) has rapidly decreased the incidence of certain errors, introducing however many more [5–7]. Therefore, high-quality clinical decision support is essential if
DNP 805 Topic 3 Discussion Question Two
healthcare organizations are to achieve the full benefits of electronic health records and CPOE. In the current healthcare setting when facing a decision, healthcare providers often do not know that certain patient data are available in the EHR, do not always know how to access the data, do not have the time to search for the data or are not fully informed on the most current medical insights. It is said the healthcare providers often drown in the midst of plenty [8–10].
Moreover, decisions by healthcare professionals are often made during direct patient contact, ward rounds or multidisciplinary meetings. This means that many decisions are made in a matter of seconds or minutes, and depend on the healthcare provider having all patient parameters and medical knowledge readily available at that time of the decision. Consequently, current decisions are still strongly determined by experience and knowledge of the professional. Also, subtle changes in a patient’s condition taking place before hospital- or ward admission are often overlooked because clinicians regularly perceive a patient in his current state without taking into account changes within normal range. A computer however, takes into account all data available making it also possible to notice changes outside the scope of the professional and notices changes specific for a certain patient, within normal limits.
nother parameter of CDSS is the approach to give advice, either passive or active. Passive CDSS require the user to do something to receive advice, for example clicking a button or opening a tab. These passive types however, have been abandoned for most part because of their lack of efficacy and dependence of human involvement [14, 15]. A challenge of active systems is to avoid the generation of excessive amount of alerts, causing alert fatigue with the user. This topic is discussed further on in the paragraph on alert fatigue. A closely related characteristic commonly used to categorize CDSS is thestyle of communication, distinguishing a consulting and critiquing model. In a consulting model the system is an advisor, asking questions and proposes subsequent actions. For example, when entering a medication order, the computer asks for the diagnosis and advises the right dose or an alternative treatment. A critiquing system lets the user decide the right dose for itself and only afterwards alerts the user that the dose prescribed for this therapy is too low.
Human computer interaction is another clinical decision support system characteristic. How does a user interact with the computer? Historically CDSS were slow, difficult to access and difficult to use. However, modern day computing power, electronic health record integration and computer mobility have made these problems of the past. However, human computer interaction is still a good way to categorize CDSS describing EHR integration or overlay, keyboard or voice recognition and advice by means of pop-ups, acoustic alarms or messaging systems.