Clin Transl Oncol 2006;8:821–825. In the first type of interaction, a clinician solicits advice from the CDSS. Seven of eight relevant systematic reviews found a positive effect on provider or patient behavior. CDDS interventions found a significant impact on multiple outcomes relevant to antibiotic stewardship. An analysis of bone metastases pathway in a large, integrated National Cancer Institute-Designated Comprehensive Cancer Center Network. Manuscript preparation and final approval: All authors. HealthIT.gov website. Pain 2009;147:20–28. This question is for testing whether or not you are a human visitor and to prevent automated spam submissions. Evid Rep Technol Assess (Full Rep) 2012;203:1–784. Improving modern cancer care through information technology, Delivering High-Quality Cancer Care: Charting a New Course for a System in Crisis. Support Care Cancer 2010;18:847–858. A large part of any physician’s work, especially in non-procedural disciplines, involves acquiring information and then, aided by evidence and experience, making decisions for the best possible outcome. Likewise, HIT targeting behavioral change is less likely to be beneficial compared with HIT targeting improved decision-making. Clinicians and researchers have long envisioned the day when computers could assist with difficult decisions in complex clinical situations. Medical Informatics: Computer Applications in Health Care and Biomedicine. A recent review of 57 randomized controlled trials and 10 systematic reviews evaluated the effectiveness of computer-based delivery of health evidence, including CDSS. Berner ES. Ash JS, McCormack JL, Sittig DF, . The effectiveness of computerized clinical guidelines in the process of care: a systematic review. A clinical decision support system (CDSS) is a system designed to support clinical decisions during a diagnostic or therapeutic care process. [3], The QMR system uses an ingenious algorithm modeled on the clinical reasoning of a single University of Pittsburgh internist. Strengths of this systematic review include the study team, comprising a research librarian, 2 practicing oncologists, and an oncology clinical pharmacist. This act results in a digital message entering the hospital information system. Heidelberg: Springer-Verlag, 1997:261-276. The study team made every effort to identify all publications meeting the inclusion criteria. J Clin Oncol 2011;29:1029–1035. Meaningful community collaboration in research, Non-adherence to public health recommendations: Call the psychotherapists, Beyond the day-to-day practice of medicine, Green: The most suitable color for hospital textiles, Updates to BC Cancer Cervix Screening affecting primary care, Geriatric depression: The use of antidepressants in the elderly, Changes to medical staff privileging in British Columbia, Timing of return to work after hernia repair: Recommendations based on a literature review. Beer J, Dobish R, Chambers C. Physician order entry: a mixed blessing to pharmacy? In general, the outcomes associated with use of clinical pathway systems were compared with usual care; however, one study compared use of an electronic clinical pathway with a paper pathway.34 Most studies were framed as reporting favorable outcomes, including reduced acute care use,32,35 increased guideline concordance and reduced symptoms,33 improved identification of eligible subjects for clinical trial participation,36 and improved hemoglobin levels among patients with anemia.37 The comparison between web- and paper-based pathway systems did not show a significant difference in pathway deviations between them.34, The remaining 6 studies assessed CDS systems in CPGs (n=2),38,39 PROs (n=3),40–42 and oncology-specific prescriber alerts (n=1).43 One study evaluated CPG concordance with CDS and demonstrated a significant increase in guideline adherence (P38 Furthermore, adherence to CPGs with CDS system advice was >90% when the CDS tool included CPG recommendations.39 CDS tools for obtaining PROs and reporting the results to clinicians showed increased discussion of symptoms and quality-of-life issues (P=.03) and symptom monitoring during routine clinical care.40–42 Patients reported a high ease of use and minimal time required; however, patient satisfaction was similar between intervention and control groups. Comparative studies that report outcomes of care include those of CDS systems with CPOE, clinical pathways, CPGs, PROs, and provider alerts. Washington, DC: The National Academies Press; 2013. Key features that appear to support positive outcomes include real-time information and point-of-care action. J Am Med Inform Assoc 2003;10:94-107. The objective of this study was to assess the effectiveness of EBMeDS use in improving diabetes care. [12], How to represent complex clinical guidelines in computer applications is an area of considerable research[13] . There are various types of CDSS implementations, both active and passive (provider initiated). They assist with interpretation, diagnosis, and treatment. J Oncol Pract 2011;7:218–222. [Context Link] 15. Hanauer DA, Zheng K, Commiskey EL, . eHealth for a Healthier Europe! Computer-based clinical decision support systems and patient-reported outcomes: a systematic review. While in experimental tests the system could be as good as a panel of clinicians, MYCIN was never widely used because of difficulties with maintenance and incorporating the system into a clinician’s workflow. Hripcsak GH. Van Erps J, Aapro M, MacDonald K, . In many clinical decision support systems, a two-layer knowledge base model (disease-symptom) of rule reasoning is used. Accessed September 13, 2018. Basch E, Deal AM, Kris MG, . This multicenter retrospective study sought to determine clinimetric performance of a cloud-based computerized sepsis clinical decision support system (CDS), understand the epidemiology of sepsis, and identify opportunities for quality improvement. Effects of clinical decision-support systems on practitioner performance and patient outcomes: a synthesis of high-quality systematic review findings. Effects of computerized clinical decision support systems on practitioner performance and patient outcomes: a systematic review. Do clinical decision support systems improve patient care? The ICMJE is small group of editors of general medical journals who first met informally in Vancouver, British Columbia, Clinical decision support system Antibiotic Stewardship (ABS) Programs are implemented to ensure the rational use of antibiotics [ 7 ]. New York: Springer-Verlag, 2001:573-609. Harris AD, McGregor JC, Perencevich EN, . Author contributions: Study concept and design: Pawloski, Brooks, Nielsen. Musen M, Shahar Y, Shortliffe EH. A total of 23 studies reported improvement in key study outcomes with use of oncology CDS systems, and 12 studies assessing the systems for computerized chemotherapy order entry demonstrated reductions in prescribing error rates, medication-related safety events, and workflow interruptions. Multidisciplinary pain management based on a computerized clinical decision support system in cancer pain patients. Table 1 describes the characteristics of the included studies. However, the labor-intensive, often biased process of entering findings limits its utility. Small MD, Barrett A, Price GM. CDS systems incorporated into clinical pathways have been associated with increased guideline adherence,32–37 demonstrating the benefit they can provide to clinicians, and consistent with findings of previous systematic reviews also showing a positive impact on guideline adherence.10,44 Three studies included in our analysis evaluated the use of CDS systems for PROs, and all demonstrated benefit for ≥1 outcome.40–42 These findings differ somewhat from those of a systematic review of 15 studies that assessed the effect of CDS systems on PROs, which showed a positive effect on symptoms in 3 studies (20%).45 A CDS system used with prescriber alerts demonstrated a positive impact, which is consistent with findings of a previous study.43,46, The findings are also consistent with those of a meta-analysis assessing the impact of health information technology (HIT) on cancer care from 2000 to June 2014.47 CDS systems were the most common (66%) HIT intervention identified and were implemented across several cancer types, including breast, colorectal, and prostate, for detection, diagnosis, and treatment but not for survivorship or end-of-life care. Like MYCIN, this program was found to function as well as practising clinicians. Clinical Decision Support Systems: State of the Art. Clinical Decision Support Systems (CDSS) provide aid in clinical decision making and therefore need to take into consideration human, data interactions, and cognitive functions of clinical decision makers. N Engl J Med 1982;307:468-476. A New Market Study, titled "Clinical Decision Support Systems (CDSS) Market Upcoming Trends, Growth Drivers and Challenges" has been featured on WiseGuyReports. A more recent Canadian report[11] called for investment in information-technology infrastructures that support the standardized identification, reporting, and tracking of patient safety data. Here the information in the message is compared with all relevant rules. Clinical decision support is any tool that provides clinicians, administrative staff, patients, caregivers, or other members of the care team with information that is filtered or targeted to a specific person or situation. The Figure provides a blueprint for a health information system that has evolved from one first developed for the US National Library of Medicine in the early 1980s. Data analysis and interpretation: Pawloski, Brooks, Nielsen. Chang PL, Li YC, Lee SH. 1. van der Lei J. Clinical decision support through an electronic health record has been proposed as a promising approach to improving guideline-based care. pagination, the shorter form provides sufficient information to locate the reference. Published studies of CDS systems are largely associated with positive outcomes, and their findings consistent with those of studies conducted in the noncancer population. Potential drawbacks may be the need to access separate systems and increased workflow for prescribers or other clinicians. Kaushal R, Shojania KG, Bates DW. Methods: A systematic review of peer-reviewed studies was performed to evaluate clinically relevant outcomes related to the use of CDS tools for the diagnosis, treatment, and supportive care of patients with cancer. to save searches and organize your favorite content. J Clin Oncol 2016;34:557–565. patients. The systems used are usually referred to as clinical decision support systems or CDSS.[1]. Electronic clinical decision support (CDS) systems can potentially improve cancer care quality and safety. The use of CDSSs to facilitate evidence-based medicine therefore promises to substantially improve health care quality. Opportunities for a better use of healthcare resources. Clinical decision support systems (CDSSs) have been hailed for their potential to reduce medical errors1 and increase health care quality and efficiency.2At the same time, evidence-based medicine has been widely promoted as a means of improving clinical outcomes, where evidence-based medicine refers to the practice of medicine based on the best available scientific evidence. The areas addressed may include foundations, functionality, interfaces, implementation, impacts, and evaluation of decision support systems (DSSs). Such systems have been shown to decrease inappropriate X-ray orders by as much as 47%.[9]. Opportunities for a better use of healthcare resources. HealthPartners Institute is an Affiliate Member of the HCS Research Network. 09-0069-EF. Common roles for CDS include computerized physician order entry (CPOE) and electronic health record (EHR) clinical reminder systems.2. In PubMed, the MeSH terms defined the concepts of cancer and CDS systems, medical order entry systems, or clinical pathways. One study evaluated prescriber alerts with CDS tools and demonstrated that hard stops for hepatitis B screening before chemotherapy treatment were associated with increased screening (99.3% vs 40.2%; PP43. Blois MS. Clinical judgment and computers. Robust quasi-experimental study designs, such as interrupted time series designs with a comparator group, were rare. In a manner consistent with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement, we conducted a comprehensive review of the clinical and scientific literature.19 A trained health sciences librarian (B.A.O.B.) Features of effective computerised clinical decision support systems: meta-regression of 162 randomised trials. BMJ Open 2012;2:2. This systematic review assessed evidence supporting the use of CDS systems in cancer care delivery from studies evaluating cancer diagnosis, treatment, and supportive care. J Am Med Inform Assoc 2008;15:453–460. Dr Ansermino is a member of the Centre for Health Innovation and Improvement (CHIi) and a pediatric anesthesiologist at BC’s Children’s Hospital. J Am Med Inform Assoc 2003;10:573–579. It is crucial that clinicians be involved in the development and rigorous scientific evaluation of these systems. The primary findings show that the beneficial impact differed across the cancer continuum; HIT for diagnosis and treatment was less likely to be associated with benefit compared with prevention. Assessment of efficiency and safety of the comprehensive Chemotherapy Assistance Program for ordering oncology medications. Disclosures: The authors have not received any financial consideration from any person or organization to support the preparation, analysis, results, or discussion of this article. Clinical oncology is a dynamic, multidimensional healthcare specialty with complex decision-making and care coordination needs and multiple handoffs between primary and specialty care providers.16 In 2013, the Institute of Medicine reported that the cancer care delivery system was in crisis due to a lack of patient-centric care, palliative care, and evidence-based decision-making.17 CDS systems have the potential to significantly improve cancer care delivery, but there are critical gaps in the availability and use of effective CDS tools.18 To better understand the current landscape of CDS systems in oncology practice, we conducted a systematic review of the literature describing real-world implementation of CDS tools for the diagnosis, treatment, and supportive care of patients with cancer. Collins CM, Elsaid KA. These systems automate and standardize the ordering process. Our objective was to investigate the reported impact of CDS systems on clinically relevant patient outcomes. Findings from the limited studies included in this review are largely positive and consistent with most studies conducted in the general healthcare population. Washington, DC: National Academy Press, 1999. The result, a low potassium of 2.9 mmol/L, is entered into the laboratory information system. PubMed Abstract Improving modern cancer care through information technology. While implementing the IF-THEN-ELSE rule illustrated by the Brigham and Women’s Hospital hypokalemia/digoxin example is relatively straightforward, the programming of guidelines with their multiple, often subjective decision points tests the limits of scientific disciplines such as decision analysis and knowledge representation. Delivering High-Quality Cancer Care: Charting a New Course for a System in Crisis. 14. Recommendations for the Conduct, Reporting, Editing, and Publication of Scholarly Work in Rockville, MD: Agency for Healthcare Research and Quality; 2009. However, not all studies evaluating CDS systems have shown clinical practice improvements.48 Thus, it is imperative that systems and tools, both commercially and locally developed, be assessed for their effectiveness and impact on patient outcomes. The clinical decision support system(CDSS) has potential to improving medication safety. Rockville, MD: Agency for Healthcare Research and Quality; 2009. Clinical decision support systems for improving diagnostic accuracy and achieving precision medicine. Doolan DF, Bates DW, James BC. The review was conducted according to the PRISMA statement to ensure appropriate methods were used. An approach to this problem is implementation of computerized early warning tools for sepsis. Clinical Decision Support. [1] The two most famous examples are the MYCIN and QMR systems. Clinicians are confronted by increasing amounts of clinical data for each patient they treat as well as an exponentially increasing volume of relevant medical research. N Engl J Med. Included studies assessed ≥1 of the following: clinical outcomes (including patient-reported outcomes [PROs]), costs, and care delivery process measures (eg, medication prescribing error rates or compliance with clinical practice guidelines [CPGs]). J Oncol Pharm Pract 2002;8:119–126. 5 In the report, the agency described clinical decision support as technology that “provides healthcare providers and patients with knowledge and person-specific information, intelligently filtered or presented at … J Am Med Inform Assoc 2016;23:420–427. A 1999 report from the Institute of Medicine,[10] revealed the magnitude of ongoing medical error, documenting as many as 7000 annual deaths in the US due to medication errors in hospitals. Using computerized decision support to improve compliance of cancer multidisciplinary meetings with evidence-based guidance. vol. Enhancing patient-provider communication with the electronic self-report assessment for cancer: a randomized trial. Garg AX, Adhikari NK, McDonald H, . PubMed Abstract The largest category of studies included in our review comprises studies evaluating the use of CPOE systems in oncology care. Examples of various types of clinical decision support systems include diagnostic support such as MYCIN and QMR, alerts and reminders based on the Arden Syntax, and patient management systems that use computer representations of patient care guidelines. Ottawa: National Steering Committee on Patient Safety, 2002. However, research has shown that none of these CDSSs are capable of differentiating among primary headaches with overlapping features. Qual Saf Health Care 2006;15:418–421. 2004 , Dr J. in Medical Journals, visit www.icmje.org. For optimal retrieval, all terms were supplemented with relevant title and text words. We urge clinicians to identify opportunities for CDSS and to advocate within their health care settings for the development of systems that bring about meaningful improvement of health outcomes. PubMed Abstract Full Text The Evidenc… Patient 2015;8:397–409. Vancouver Group. The types of CDSS available are as broad as human ingenuity allows: from personal digital assistant applications customized by a single clinician to multihospital mainframe-based surveillance systems meant to assure care for thousands of patients. Similar CPOE systems can be successful in a wide variety of settings, with some of the most compelling uses being the prevention of drug dose and interaction errors. While electronic health records and databases help physicians manage this rising tide of information, patient-specific recommendations provided by clinical decision support systems can do even more by improving decision making and helping ensure patient safety. Journal of the National Comprehensive Cancer Network J Natl Compr Canc Netw, Enabling health care decisionmaking through clinical decision support and knowledge management, Clinical decision support systems for improving diagnostic accuracy and achieving precision medicine, A roadmap for national action on clinical decision support, Standard practices for computerized clinical decision support in community hospitals: a national survey, The development of primary care information technology in the United Kingdom, Features of effective computerised clinical decision support systems: meta-regression of 162 randomised trials, Improving clinical practice using clinical decision support systems: a systematic review of trials to identify features critical to success, Effects of computerized clinical decision support systems on practitioner performance and patient outcomes: a systematic review, Systematic review: impact of health information technology on quality, efficiency, and costs of medical care, A risk analysis method to evaluate the impact of a computerized provider order entry system on patient safety, Effects of computerized physician order entry and clinical decision support systems on medication safety: a systematic review, Effect of clinical decision-support systems: a systematic review. Cramer K, Hartling L, Wiebe N, et al. Kowamoto et al8 identified features of CDS systems critical for improving clinical practice in any clinical setting, including (1) automatic provision of decision support as part of clinician workflow; (2) provision of recommendations compared with assessments; (3) provision of decision support at the time and location of decision-making; and (4) computer-based decision support. to help authors and editors create and distribute accurate, clear, easily accessible reports of biomedical studies. Hunt DL, Haynes RB, Hanna SE, . However, the effects of the intervention were conflicting and uncertain. Osheroff JA, Teich JM, Middleton B, . A risk analysis method to evaluate the impact of a computerized provider order entry system on patient safety. Enabling health care decisionmaking through clinical decision support and knowledge management. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement, Reduction in chemotherapy order errors with computerised physician order entry and clinical decision support systems. Friedman CP, Elstein AS, Wolf FM, et al. To Err Is Human: Building a Safer Health System. However, with the burgeoning amount of data now available for each patient and the increasing body of medical evidence, we need tools to help us make rational decisions based on all this information. This message contains, among other things, the patient’s hospital ID number and the potassium result. Adeboyeje G, Agiro A, Malin J, . 1 The authors found no significant improvement in clinical outcomes in the subset of 30 trials that included them. There is no period after the journal name. Jenders RA, Hripcsak G, Sideli RV, et al. 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