Essay on Clinical Decision Support System

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,

Standing (2011), defines clinical decision-making as a complex process that involves observation, gathering information, critical thinking, evaluating evidence, applying necessary knowledge, reflection and problem-solving skills. Every day nurses make important clinical decisions and these decisions have important implications for patient outcomes and deserve serious consideration. Therefore, it is important for nurses to have a better insight of the decision-making process, be able to deliver holistic care and meet essential and complex physical and mental health needs of the patient.

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

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.

Clinical decision making is a complicated process that depends on human capability to provide full attention to memorize, and create enormous amounts of data to all areas. IT systems are able to access information, arrange them, and recognize links between them. Clinicians often ‘know’ information such as a patient’s allergies, drug interaction and if that drug is on recall.

Medical codes are used for various recording and reporting purposes within the medical industry. These codes can determine the diagnoses and treatments used in patient care, as well as the mortality and morbidity data that provide statistics. As time and technology progresses a strain has been amplified on coding systems used today that warrants a major update. The United States (US) has yet to implement the most current standardized set of medical codes that have been adopted by the rest of the developed world. This delay in part caused by Congress and the American Medical Association (AMA) is causing the American population to suffer in various ways. As implementation dates are being pushed back time and time again the field is increasing debt by lost opportunities and still not able to communicate medical data across US borders. The International Classification of Diseases , tenth revision (ICD10) can, with the help of the Affordable Care Act (ACA), reduce costs for medical treatment for patients and facilities as well as improve upon facility efficiencies and quality of care. Healthcare providers in the United States (US) should be mandated to implement current sets of International Classification of Diseases (ICD) without further delay to reclaim the forefront of medical care against the top-rated systems of other countries around the world.

In order to create a more efficient, patient-centered healthcare system, HIT must begin to focus on providing data in a fashion that is accurate, timely, and interoperable. By doing so, we reduce the risks of errors due to misinformation, reduce treatment cost caused by repetitive treatments and testing, and begin to focus on using information to prevent maladies rather than cure. Although the US is clinically advanced, they have not figured out a way to deter the rising costs of healthcare caused by preventable error (Matthew Scholl, 2010). There are several documents that pertain to the use of HIT to accomplish this in a standardized method.

Clinical decision-making (CDM) identify by the method including skills such as critical judgment and problem solving which is also keystones of the effective care of patient (Wainwright, Shepard, Harman and Stephens, 2011). As Physical therapists (PTs) we make decision every day. This decision is accepted throughout the client interview and verified during physical examination (Goodman and Snyder, 2007). The decision making style may differ based on level of experience, knowledge, judgmental power and condition like limited time frame.

Systems without a knowledge base, on the other hand, rely on machine learning to analyze clinical data. There are pros and cons to implementing clinical decision support systems. The foremost challenge is that a CDSS must be integrated with a healthcare organization 's clinical workflow, which is often already complex. Some clinical decision support systems are standalone products that lack interoperability with reporting and electronic health record (EHR) software. Furthermore, incorporating large amounts of data into existing systems places significant strain on application and infrastructure maintenance. CDSS is "a process for enhancing health-related decisions and actions with clinical knowledge and patient information to improve health and healthcare delivery.

Throughout the course of Health Information 371, we have looked at various tools that are used or could be used in the field to help design, build, and implement systems. These tools explored concepts that were mostly related to the medical standpoint on how to diagnose patient’s through decision-making techniques. This helps the health professional make an accurate diagnosis based off of evidence and not speculation. Within the Health Information field, as informatics specialists we need to consider all of these techniques when designing the systems, creating policies, and updating the servers. Having knowledge on these tools will assist us when creating technologies, which will give health professionals all the necessary techniques to give the patient the best possible care available. Four tools that I believe will have a significant potential to affect my approach while practicing

Clinical Decision Support is an important tool for clinicians, staff, patients and other persons because it provides these individuals with knowledge and information with the aim of enhancing health and healthcare. It encompasses various elements that make the decision making process more effective within the clinical workflow. They include computerized alerts to care givers and patients, focused data report on patient status, clinical guidelines, documentation templates, and contextual relevant reference. This essay will critically analyze strategy that can be employed to enhance the integration of various aspects of patients with the CDS and means through which efforts can be prioritized in a team. This will include CDS intervention meeting meaningful use requirements and other areas of institutional priorities where clinical improvement can be achieved.

APACHE stands for Acute Physiology and Chronic Health Evaluation and the first system was developed in 1981. The newest APACHE system was developed in 1991. The APACHE III system was designed to predict an individual 's risk of dying in a hospital. It compares each individual 's medical profile against nearly 18,000 cases in its memory before reaching a prognosis that is, on average, 95 percent accurate (Open Clinical website, 2005). This system can be used in the Intensive Care Unit setting and it can predict the patient’s risk of dying in the Intensive Care Unit. This system takes into account several variables such as, diagnosis and psychical conditions upon admission to the Intensive Care Unit, age, pre-existing medical disorders and other variables. A physician gives the system facts, and based upon the facts the system can predict the patient’s risk of passing away. This system does not spit out an answer and healthcare workers have to follow it, it is rather a tool to help healthcare providers make a decision on whether to discontinue “heroic” measures and it allows them to ponder these issues in a realistic way. The Clinical Decision Support System is a system that uses patient data to generate specific advice relevant to the patient’s case. Clinical DSSs are typically designed to integrate a medical knowledge base, patient data and an inference engine to generate case specific advice. (Open Clinical website, 2006). Overall, this system can be helpful when

Wager, K. A., Lee, F. W., & Glaser, J. P. (2009). Health care information systems: A

What advice patients are given by their clinical nurses or consultants is very important and needs to be carried out by the patient on an ongoing basis and not just I week before and 1 week after a clinic appointment. This is an area where I think Data analytics can help improve individuals control.

Having a single view of the patient and their treatment and recovery plan is invaluable in ascertaining which are the most and least effective tactics in treatment. The 360-degree view of the patient and the many processes supporting them is crucial for increasing the accuracy, effectiveness and performance of treatment programs over time (Blakeman, 1985). Computerized management systems are critical for organizing, analyzing and translating the massive amount of data captured on patients, treatment and recovery processes, and the use of supporting IT systems to optimize patient health and organizational provider performance (Peshek, Cubera, Gleespen, 2010). The ability to aggregate and intelligently use all available data, information, patient-based and process-generated data to deliver higher levels of quality care is possible when computerized management systems are used throughout healthcare organizations.