comp5 unit7a lecture slides

History of Health Information Technology in the U.S.History of Clinical Decision

Support SystemsLecture a – What is CDS?

This material Comp5_Unit7 was developed by The University of Alabama Birmingham, funded by the Department of Health and Human Services, Office of the National Coordinator for Health Information Technology under Award Number

1U24OC000023

History of Clinical Decision Support Systems

Learning Objectives

2

• Describe various types and structures of clinical decision support (CDS) systems

• Discuss the evolution of clinical decision support from expert system research

• Discuss the changes in focus of clinical decision support from the 1980s to the present

• Discuss the change in architecture and mode of access of clinical decision support systems from the 1980s to the present

• Describe some of the early clinical decision support systems• Discuss the historical challenges in implementing CDS

Health IT Workforce Curriculum Version 3.0/Spring 2012

History of Health Information Technology in the US History of Clinical Decision

Support Systems Lecture a

Overview

• Definition• Types of CDS• “Classic” clinical decision support systems• Examples of CDS and how they evolved• Evolution of CDS architecture• Challenges to be overcome

3Health IT Workforce Curriculum Version 3.0/Spring 2012



CDS Definition

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 healthcare.

Source: (Osheroff, et al., 2007)




Knowledge and Information

• General Medical Knowledge and Information– Disease, diagnosis, medications, treatments– Formularies, guidelines, requirements




Knowledge and Information

• General Medical Knowledge and Information– Disease, diagnosis, medications, treatments– Formularies, guidelines, requirements

• Patient-Specific Information– Patient’s signs, symptoms– Allergies– Lab results




Filtered

• For the particular clinician• Usable form• Context sensitive• Tailored to patient




Appropriate Time

• At the point of decision making• When new data arrives• To stop dangerous decisions• When clinician requests it• Appropriate frequency




Enhance Health and Healthcare

• EHRs without CDS– Accessible– Legible– Complete

• Added value of CDS– Improve quality– Greater return on investment

Source: (Johnston, et al., 2004)




Improve Quality

• Improve adherence to guidelines– Avoid inappropriate procedures




Improve Quality


• Avoid diagnostic/therapy errors– Drug Interactions– Delay in diagnosis




Improve Quality


• Avoid diagnostic/therapy errors– Drug Interactions– Delay in diagnosis

• Minimize problem severity/complications– Early alerts to abnormal lab values– Alerts to adverse drug events– Diagnostic screening reminders– Immunization reminders

Source: (Classen, et al., 1997)




Taxonomy of Interventions

• Documentation forms/templates• Relevant data presentation• Order creation facilitators• Time-based checking/protocol, pathway support• Reference information and guidance• Reactive alerts and reminders

Source: (Osheroff, 2009)




“Classic” CDS

• Origin– Expert systems research– Medical process improvement




“Classic” CDS


• Intent– Assist clinician– Provide information for user

Source: (Miller & Masarie, 1990)




“Classic” CDS


• Intent– Assist clinician– Provide information for user

• User’s Role– Filter information– Interact with system




CDS Structure

• Knowledge Base

• Inference Engine • Communication Mechanism




CDS Structure

• Knowledge Base– Compiled information– If-then rules– Other types of associations




CDS Structure

• Knowledge Base– Compiled information– If-then rules– Other types of associations

• Inference Engine – Model/formulas for combining the knowledge

base with patient-specific data




CDS Structure

• Knowledge Base– Compiled information– If - then rules– Other types of associations

• Inference Engine – Model/formulas for combining the knowledge base

with patient-specific data• Communication Mechanism

– Input of patient data– Output of information to user




"Classic” CDS




History of Clinical Decision Support Systems

Summary – Lecture a

26

• Definition• Types of CDS• “Classic” clinical decision support systems

Health IT Workforce Curriculum Version 3.0/Spring 2012



Some of the material in this presentation is also included in the following and is used with permission:

Berner ES, La Lande TJ. Overview of CDSS. In: Berner ES, editor. Clinical decision support systems: theory and practice. 2nd ed., New York: Springer; 2007, p. 3-22.




History of Clinical DecisionSupport Systems

References – Lecture a




References• Berner ES, La Lande TJ. Overview of CDSS. In: Berner ES, editor. Clinical decision support systems: theory and practice. 2nd ed., New

York: Springer; 2007, p. 3-22.• Classen DC, Pestotnik SL, Evans RS, Lloyd JF, Burke JP. Adverse drug events in hospitalized patients. Excess length of stay, extra costs,

and attributable mortality. JAMA. 1997 Jan 22-29;277(4):301-6.• Johnston D, Pan E, Walker J. The value of CPOE in ambulatory settings. J Healthc Inf Manag. 2004;18(1):5-8.• Miller RA, Masarie FE Jr. The demise of the "Greek Oracle" model for medical diagnostic systems. Methods Inf Med. 1990 Jan;29(1):1-2.• Osheroff J, editor. Improving medication use and outcomes with clinical decision support: a step-by-step guide. 1st ed. Chicago: HIMSS,

2009.• Osheroff JA, Teich JM, Middleton B, Steen EB, Wright A, Detmer DE. A roadmap for national action on clinical decision support. JAMIA

2007;14:141-5.

comp5 unit7a lecture slides

Documents