Clinical Decision Support

In today’s society, the accuracy of health information, the availability of health records, and the professional resources in which one live are vital in decision making for health conditions. Meaningful Use (MU) is a program developed by CMS Medicare and Medicaid that awards, incentives in the health care industry in which the certified electronic health records (EHRs) are used to improve patient care (Practice Fusion, 2016). These incentives are for professionals that care for about 30% of their adult patient volume or 20% of their children’s volume for Medicare and Medicaid patients (CMS, 2016). In addition, adjusting from paper charts to electronic charts of patient’s information is beneficial for MU. Furthermore, the American

Therefore, CDS systems are often combined with electronic health record (EHR) to reorganize workflow and existing data sets. In contrast to patient health paper records, EHR is a digital version of a patient’s paper chart. EHR contains the medical and treatment histories of patients (“What Is an Electronic Health Record (EHR)?”). EHR system is built to go beyond standard clinical data collected in a provider’s office and can be inclusive of a broader view of a patient’s care (“What Is an Electronic Health Record (EHR)?”). It is essential to have CDS systems in the healthcare setting because it supports several aspects of patient care decision making. For example, the use of rule-based CDS systems for the mechanical ventilation of patients with acute respiratory distress syndrome (ARDS) resulted in sixty percent survival rate compared to an expected survival rate of approximately thirty-five percent (Nelson, Stagger, 2014). Thus, CDS systems can make a difference in life or death with patients’ assessment and or diagnosis. CDS system tools are intended to remind the provider or nurse about specific care needs, along with, alerting a specific care action that may impose a risk to the patient, and or provide available online knowledge resources (Nelson, Staggers,

Health informatics consists of many components, the main components focused on are electronic medical records, clinical decision support systems, and telemedicine. The electronic medical record (EMR) is a medical record in digital format. EMR's facilitate access of patient data by clinical staff at any given location, accurate and complete claims processing by insurance companies, building automated checks for drug and allergy interactions, clinical notes, prescriptions, scheduling, and sending /viewing of labs. Research has shown that electronic health records provide greater accessibility, accuracy, and completeness of clinical information: therefore reducing uncertainty[2]. Clinical decisions support systems are computerized systems designed to assist physicians and other health professionals in decision making. Telemedicine is the use of information technology and communication to deliver care. Telemedicine uses electronic information and communications technologies to provide medical diagnosis and/or patient health care when distance separates the participants.

Computerized Physician Order Entry (CPOE) is a complex technology mandated by Centers for Medicare Services (CMS) in Meaningful Use criteria for adoption by healthcare providers (Self & Coffin, 2016). CPOE is technology for reduction in medication errors through implementation of standardization of processes to support legibility and reduction in the number of people required to participate in the order workflow, thus decreased delays and errors result due to miscommunication (Hoonakker et al., 2013). Although CPOE highlights improvement in quality and safety, healthcare organizations have expressed difficulty in the implementation due to physician resistance (Hoonakker et al, 2013). This resistance not only contributes to patient safety

Gawande’s (2015) article “Overkill,” suggests that physicians overprescribe drugs and tests which are ultimately unnecessary for patients. To eradicate such behavior, I would implement an electronic health record (EHR) with the following functions: Computerized provider order entry (CPOE) with a clinical decision support system (CDSS) to assist physicians/clinicians (stakeholders) in their medical practice or at hospitals. These functions will help to alleviate redundant tests and make suggestions about treatment. According to HealthIT.gov (2014), CDSS caters chiefly to drugs, laboratory testing, radiology procedures, and helpful clinical literature (HealthIT.gov, 2014).

As the technology is being implemented in health care system, computerized provider order entry (CPOE) has become the standard of care in most hospitals. According to Cherry and Jacob (2014), “CPOE contributes to safety and quality by eliminating lost orders automatically, monitoring for duplicate or contradictory orders, and reducing time to fill orders” (p 256). However, there are some barriers using the system which leads to medical errors including alarm However; some barriers are using the system which leads to medical errors including alarm fatigue, lack of communication, and clinicians’ hesitance to adapt to new system. CPOE alert physicians on a constant basis about “various drug-drug, drug-patient, and guideline-based recommendations during the ordering process” causing alert fatigue in clinicians (Payne & Weir, 2015, p 6).

Meaningful use is defined as using certified electronic health record (EHR) technology. It is important to healthcare because of the following; quality, safety and efficiency which reduces health disparities by having computerized physician order entry (CPOE) to document all medical orders that other health care providers inside and outside the hospital to be aware of health management. Maintaining an active medication lists ensuring that any health care provider working with a patient is aware of most or all the medications that a patient is being treated with, and allows the EHR system to make the health care provider aware of any controlled medications, allergies, or drug-drug interactions. Implementation of clinical decision support rules

Clinical support systems can also allow for patient-specific alerts, situation-specific alerts, and assist physicians with order sets to facilitate decision making which enhance the effectiveness and quality of care. 2. The critical difference between a clinical decision support system and a personal health record is that the two differ greatly in the degree to which they interpret data and recommend patient-specific action (Cimino & Shortliffe, 2014, p.190). A clinical decision support system are clinical systems that allow clinicians to consult expert knowledge for the diagnosis and treatment planning of the patient.

For policymaking, regulations and strategies, clinical decision support (CDS) provides clinicians, staff, patients or other individuals with knowledge and person-specific information, intelligently filtered or presented at appropriate times, to enhance health and health care. CDS encompasses 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, and contextually relevant reference information, among other tools.

Another information system that has increased the ability of the physician to appropriately treat patients is a computerized physician order entry system (CPOE). “Using CPOE systems for entering orders for tests, drugs, and other procedures has led to reductions in transcription errors, which have led to demonstrable improvements in patient’s safety.” (NCBI) “More generally, medical errors (a leading cause of adverse events and other ills) are expensive, increase patient hospital length of stay, and cost human lives.” (Fichman/Kohli/Krisman) The utilization of these systems, decreases those errors that lead to increased costs. Medical errors in treatment or errors in the transcription of drug dosages are greatly decreased by the CPOE systems. These errors lead to malpractice suits that drive up the cost of insurance for the physicians and facilities. Having the COPE systems that reduce those errors causing damage and possibly death, also reduces the cost of medical malpractice insurance, the cost of which has driven many good practitioners to leave their fields and join the world of private sector testing and research.

Hunt, D.L. and Haynes, R.B. et al. 1998. Effects of computer based clinical decision support

Over the years, several studies have discussed the high rates of safety problems that patients experience during hospital stays. A particular study found that adverse events occur in as many as one-third of hospital patients (Classen et al., 2011). This regularly occurs in Jones Hospital. An additional benefit of the EHR, according to the Agency for Healthcare Research and Quality (2009), includes the ability to improve safety and overall care through clinical decision support (CDS) functionality. CDS can provide support to clinicians at various stages in the care process. It can be used to ensure accurate diagnoses, screen for preventable diseases, or avoid adverse drug events. CDS can alert a clinician to errors such as duplicate testing or drug interaction during the prescribing process.

She continues to state that some templates are designed to capture information from the patient automatically, without the physician actually examining the patient, which not only provides the patient with low quality care but it can also be seen as fraud when documenting services that were not performed but payed or overpaid (Bowman, 2013). Bowman states that clinical decision support systems are another reason to why errors are occurring while using an EHR. According to Bowman, some clinical decision support systems are not programed with the most up to date medical decision knowledge and thus provide inaccurate information. It is important to understand and keep in mind that although clinical decision support systems can be very beneficial in providing assistance with clinical knowledge, it is still a manmade product and can have technical flaws which can lead the provider to have an inaccurate diagnosis and valuable information (Bowman, 2013). Often times, this type of systems can cause the physician to solely depend on the information the system is giving them, thus ignoring their own personal knowledge and education (Bowman, 2013). Lastly, this article also states that other errors arising when using an EHR are those derived from “order entry errors, chart completion errors, chart management errors, and data entry errors” (Phillips, Win, & David,

In 1999 the Institute of Medicine (IOM) released a report that shook the world. “To Err is human” warned and informed the healthcare industry that a need for change is necessary. The lack of consistency in the delivery of the quality of care that is provided to the US population. In response, Clinical decision support systems (CDSS) have become a resolution for such an issue. The objective of this paper is to highlight the benefits of implementing a CDSS as well as the challenges faced today when implementing such a system. Furthermore, study will be conducted to explore what can be done to further research and recommendations will be given as to how CDSS implementation can improve health outcomes. Clinicians, staff as well as patients are

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