Assignment 1: Clinical Decision Support Systems In Healthcare

UHN in Toronto is a major community care network that reaches out to and provides care to the masses. However in order to provide this kind of care they must have a very powerful decision support system. UHN utilizes an advanced CPR to support computerized physician order entry (CPOE). (Wu, Perters, & Morgan, 2002) A CPR system is a computer-based patient record system. A CPR system must provide a comprehensive clinical decision support it must include both a patient focus and a population focus. The physical computer system that is installed on the computers at UHN is called Patient 1® which is a clinical information system developed by Atlanta Based Per-Se

It is shocking to know that every year 98000 patients die from medical errors that can be prevented(Kohn, L. T., Corrigan, J. M., & Donaldson, M. S. (Eds.), 2000). Medical errors are not a new issue in our healthcare system; these have been around for a long time. Hospitals have been trying to improve quality care and patients safety by implementing different strategies to prevent and reduce medical errors for past thirty years. Medical errors are the third leading cause of death after heart disease and cancer in America (Allen, 2013). In addition medical errors are costing our healthcare system an estimated $735 billion to $980 billion (Andel, Davidow, Hollander, & Moreno, 2012).

An interview with an Assistant Professor at Duke University Health System in the Department of Medicine, Maestro Care Provider Champion and Clinical Content Architect. This physician works to incorporate clinical decision support tools into the electronic health record at Duke Health System. He manages the best practice advisory committee that may provide a way to deploy alerts to clinicians at the point of care. Alerts with order sets and recommended actions are created and updated to notify providers of current patient care guidelines or patient safety concerns.

Millions of Americans surrender to conditions that are both preventable and manageable annually. Besides chronic diseases, researchers have identified that the third leading cause of death in America is the errors conducted by professional medical practitioners. While medicine is a highly considered field, some of the practices that contribute to the errors observed include the absence of patient safety, poorly coordinated care, and inefficient healthcare quality improvement. Significant steps that can be taken to reduce deaths caused by medical errors include good communication, cooperation, use of advanced technology and implementation of quality healthcare among

The Institute of Medicine released a report in 1999 titled To Err is Human: Building a Safer Health Care System concerning the number of medical error related deaths. The report states that between 44,000 and 98,000 medical error related deaths occur each year in hospitals across the country (Kohn, L. T., Corrigan, J., & Donaldson, M. S., 2000) In response to this report, the Institute of Medicine released Crossing the Quality Chasm: Health: A New Health Care System for the 21st Century that outlines six aims for the future of the healthcare system: safe, effective, patient-centered, timely, efficient, equitable (Institute of Medicine, 2001). These aims set to establish the quality of healthcare across the country. Quality is defined by the Institute of Medicine as ““the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge” (2001).

According to the Institute of Medicine (IOM) report, To Err Is Human, the majority of medical errors result from faulty systems and processes, not individuals (Hughes, 2008). However, due to processes that are inefficient and variable, multiple health insurance, differences in provider education and experience, and other factors that contribute to the complexity of health care the IOM has put together six aims of health care that is effective, safe, patient-centered, timely, efficient, and equitable (Hughes, 2008).

By making health information accessible across an entire Acute Care System, Cerner EHR facilitates improved safety, care and coordination by providing clinicians with real-time health information, so that they are able to make more accurately informed decisions. Their electronic health records system eliminates the need for hand-written documentation, provides medical records clarity, improves accuracy and reduces errors. Cerner’s customizable applications were specifically designed to streamline both administrative and clinical tasks. These automated processes, ensures health care professionals are better equipped to maintain and perform all key administrative manipulations of clinical data relevant to each patient of record. Cerner EHR also

The IOM’s report “To Err is Human: Building a Safer Health System” shocked the health care world and made change necessary. “To Err is Human: Building a Safer Health System” released information that reported that tens of thousands of Americans were dying each year from errors (IOM, 1999). Patient safety moved to the forefront in healthcare like never before and directives were discussed to put quality as a

Alert fatigue and using a clinical decision support system (CDS) in an electronic health record is a growing concern in health care. Although alerts and warnings in an EHR are well intended, the volume of alerts EHR end-users receive is surprising. The Agency for Healthcare Research and Quality (AHRQ) estimates that in some EHR end-users have the potential to receive over 100 CDS alerts per day (Agency for Healthcare Research and Quality [AHRQ], 2015, p. 1). This cause’s alert fatigue when the end-users become desentized to the alerts and even the most important alerts become meaningless.

For the electronic health record to be considered as a true clinical decision support system, it must be possible to access and integrate patients’ clinical information that is collected throughout their lives, guaranteeing up-to-date, safe and congruent information, immediately accessible at the place of care. Moreover, because of the considerable increase in the capacity to develop and manufacture systems that employ smart components highly integrated and miniaturized, wearable devices facilitate the home monitoring of patients with chronic diseases and their information should be integrated in existing electronic health records. Therefore, the interoperability is an essential requirement of eHealth to allow the integration of care into a

Since the 1999 report by the Institute of Medicine (IOM), To Err is Human, there have been many new efforts and initiatives to reduce the incidence of medical errors. While some people argued the report exaggerated the magnitude of the problem, others were concerned about the annual number of preventable medical errors.1 Medical errors include, but not limited to medication errors, hospital acquired infections, surgical mistakes, and communication failure.2

The Institute of Medicine’s (IOM) (1999) report To Err is Human revealed the United States healthcare system to be a rather unsafe environment for patients estimating that as many as 96,000 patients died or were seriously injured due to preventable medical errors. Incidentally, studies conducted as recently as 2011 have suggested that the actual rate of preventable medical error occurrence may be three times the IOM’s initial estimation (Andel, Davidow, Hollander, & Moreno, 2012). Statistics this extreme cannot be attributed to the mistakes or substandard practices of individual healthcare providers alone and thus it is imperative that healthcare organizations begin to seek out solutions at the system’s level (Geary, 2014). Therefore, it

The value of Clinical Decision Support Systems is having additional avenues monitoring patient’s data input. The Clinical Decision Support Systems are offering notifications of patient’s record data to specified department or medical personal.

Clinical decision-support systems (CDSS) apply best-known medical knowledge to patient data for the purpose of generating case-specific decision-support advice. CDSS forms the cornerstone of health informatics research and practice. It is an embedded concept in almost all major clinical information systems and plays an instrumental role in helping health care achieve its ultimate goal: providing high quality patient care while, at the same time, assuring patient safety and reducing costs. This computer based systems designed to impact clinician decision making about individual patients at the point in time that these decisions are made. If used properly, CDSS have the potential to change the way medicine has been taught and

At the end of this semester, our group will articulate the results related to issues faced in different domains of CDSS. Then, we will also propose our own recommendation based on the literature sources that we will review about Clinical Decision Support System.