Emerging Developments Of Clinical Decision Support Systems And The Challenges Of Knowledge Representation

Equally impressive is the implementation of Computerized Physician/provider Order Entry or CPOE. CPOE is known as one of three key patient safety initiatives by Leapfrog Group, a conglomeration of non-health care Fortune 500 company leaders committed to modernizing the current healthcare system (Huston, 2014; The Leapfrog Group, 2013). CPOE is a type of software designed to reduce errors in transcription due to illegible physician handwritings or wrongly placed decimals in dosage and strengths of medications. CPOE also gives the clinician access to Clinical Decision Support, or CDS, which is a database to assist clinicians and providers to health related information for certain patient diagnosis with care planning assistance and direction. (Huston, 2014; The Leapfrog Group, 2013). CPOE and CDS will likely be streamlined and commonly used in healthcare in the next decade which appears will likely improve patient safety as well as vastly reduce medication and

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

According to Chtourou (2013), a CDI program focuses on enhancing the accuracy of clinical documentation quality which requires a huge input from CDI specialists, heath information management professionals, coders and clinicians to collaborate together to review the quality of documentation reported/captured in order to ensure accuracy and complete of patient’s clinical encounter. As a healthcare provider, medical records that are incomplete or inaccurate often times, compromise the quality of care reporting and inevitably affect the clinical decision support system of the organization including the accuracy of reimbursement. This is reasonable since the CDI program has emerged as a new paradigm to meet the changing needs of maintaining a sound health record documentation across the healthcare industry (Hauger, 2014). Most of the CDI programs have to a great extent concentrated on boosting the Diagnosis-Related Groups (DRGs) installments by securing clinical documentation to support medical complications and co-morbidities (Hauger, 2014).

Systems – this level includes “clinical decision support system (CDSS)”. This level is ranked the highest because evidence is acquired from point-of-care databases that are linked to electronic medical records of specific patients (2015).

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.

Health care providers as well as nurses must keep track of all pertinent patient information and failure to do so leads to detrimental effect on the patient's life. CIS clinical information systems are "large, computerized database management systems that support several types of activities that include physician order entry, result retrieval, documentation and decision support". CIS is intended to replace medical records department of a hospital or any other medical institution. Physicians and clinicians can safely and quickly access information, order medication and treatments and implement appropriate care. CIS will hopefully improve productivity, increase quality care and reduce costs across the organization.

To describe this treatment, I would use the health care common procedure coding system (HCPCS). HCPCS serve to report services provided by a physician to a patient. Together with the current procedure terminology (CPT), HCPCS became the only adequate system for reporting medical services (Giannangelo, 2010).

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.

Clinical Decision Support System (CDSS) has potential chances to enhance general security, quality what's more, cost-adequacy of human services. The CDSS has existed for over four decades, yet its selection rate by therapeutic groups is not empowering even in the nations that have been a pioneer in creating them. At numerous locales, it was hazardous, slowed down in the arranging stages or never at any point endeavored. To date, CDSS is considered as an incompletely effective framework. A few current difficulties have not been enough tended to amid the improvement of CDSS. According to most recent research, the arrangements of difficulties are: enhance the human-PC interface,

Electronic Health Systems are equipped with many features that are designed to reduce medical errors and help navigate patients through the healthcare system. One system that is worth looking at is the MedicsDocAssistant™ (MDA™). MDA™ supports many features such as alerts (“MedicsDocAssistant,”). Alerts will pop up on a provider’s screen letting them know that there is something wrong with the patient’s care. Alerts can range from prescription alerts, warning physicians of potential adverse drug effects or allergy complications, to alerts pertaining to clinical decisions regarding patient examinations, procedures and screenings that may be crucial. For example, the system will alert to the physician to remind female patients of a certain age to schedule a mammogram screening. The objectives of these alerts are to aid in properly diagnosing patients, identifying gaps in care, running appropriate tests as well as improving patient outcomes (“How EHR Alerts,” 2012).

In the United State, hospitals, less than two-thirds of hospitals have any type of CDS. (Byrne et al., n.d.). We might be wondering why the use of CDC is low among health care provider, based on my study the following are some of the barriers in implantation of CDS: Usability issues (Byrne et al., n.d.). This include rate of the process of information, user what the information that he or she wanted as fasted rate as possible, it graphical User Interface is not as friendly as it should be. Secondary ,the CDS Alarms functionality include lists of possible diagnoses, drug interaction alerts, or preventive care reminders and the overused of theses alarm may lead to the clinician not paying too much attention to them as it would be seen as normal sound (Bolch, 2012).These are some of the way, in which these barrier can be remove, need for better user friendly design , if the interface is well design and easy to use more physician who like to use it in making clinical decision, There is needs for the vendor and researcher to address this design failure ("Clinical Decision Support (CDS) Initiative | AHRQ National Resource Center; Health Information Technology: Best Practices Transforming Quality, Safety, and Efficiency," 2014). It is imperative to customize CDS after it is implemented failure to do this can lead to failure. For example, disabling some of the alarm system that is redundant or lack practical value, and constantly training of clinician to ensure important reminder do receive necessary attention (Bolch,

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

There are a practically large number of prompts that can bring about the clinician to back off and examine a circumstance in light of new or unforeseen data. Not at all like alternate CDS devices, which are best when custom-made to either quick or moderate considering, the reason for cautions is to upset quick thinking and make clinicians to apply extra exertion because of data that is probably going to have been neglected. Updates can be set up to be less troublesome than alarms. The objective of updates is to make data accessible to the

There are a lot of problems and challenges involved in implementing a clinical decision support system. It is important for medical staff (doctors, administrators etc.) to be an integral part in the implementation and development of CDSS. Our limited research concluded that acceptance of such technology is not easy amongst physicians. One of the main reasons for non acceptance is that the physicians want to be a standalone entity. We plan to investigate many challenges such as lack of technical expertise, cost, integration, misdiagnosis, speed etc involved in implementation of different types of CDSS in the health care industry today. Our research paper will focus on the different decision problems involved in these challenges.