Abstract
Computerized clinical decision support systems, or CDSS, represent a paradigm shift in healthcare today. CDSS are used to augment clinicians in their complex decision-making processes. Since their first use in the 1980s, CDSS have seen a rapid evolution. They are now commonly administered through electronic medical records and other computerized clinical workflows, which has been facilitated by increasing global adoption of electronic medical records with advanced capabilities. Despite these advances, there remain unknowns regarding the effect CDSS have on the providers who use them, patient outcomes, and costs. There have been numerous published examples in the past decade(s) of CDSS success stories, but notable setbacks have also shown us that CDSS are not without risks. In this paper, we provide a state-of-the-art overview on the use of clinical decision support systems in medicine, including the different types, current use cases with proven efficacy, common pitfalls, and potential harms. We conclude with evidence-based recommendations for minimizing risk in CDSS design, implementation, evaluation, and maintenance.
Highlights
WHAT IS A CLINICAL DECISION SUPPORT SYSTEM?A clinical decision support system (CDSS) is intended to improve healthcare delivery by enhancing medical decisions with targeted clinical knowledge, patient information, and other health information.[1]
A traditional CDSS is comprised of software designed to be a direct aid to clinical-decision making, in which the characteristics of an individual patient are matched to a computerized clinical knowledge base and patient-specific assessments or recommendations are presented to the clinician for a decision.[2]
CDSS have been shown to augment healthcare providers in a variety of decisions and patient care tasks, and today they actively and ubiquitously support delivery of quality care
Summary
A clinical decision support system (CDSS) is intended to improve healthcare delivery by enhancing medical decisions with targeted clinical knowledge, patient information, and other health information.[1]. CDSS often make use of web-applications or integration with electronic health records (EHR) and computerized provider order entry (CPOE) systems. They can be administered through desktop, tablet, smartphone, and other devices such as biometric monitoring and wearable health technology. Other systems targeting patient safety include electronic drug dispensing systems (EDDS), and bar-code point-of-care (BPOC) medication administration systems.[24] These are often implemented together to create a ‘closed loop’, where each step of the process (prescribing, transcribing, dispensing, administering) is computerized and occurs within a connected system. CDSS targeting patient safety through CPOE and other systems have generally been successful in reducing prescribing and dosing errors, contraindications through automated warnings, drug-event monitoring and more.[29].
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