Chapter 8 - International Dimensions of Clinical Decision Support

Abstract

Decision support systems have been used in the United Kingdom’s health system for decades, with pioneering work on abdominal pain diagnosis carried out in the 1970s by De Dombal and colleagues. The health system in the UK is owned and run by the government, which provides opportunities for more centralized planning and management of health information systems. This has led to benefits in standardization but also to pitfalls related to top-down procurement. Today the UK is a leader in primary care EHR systems and is making increasing use of decision support systems there, as well as in systems for telephone triage such as NHSDirect. Another important area is in decision support for warfarin prescribing. In contrast, many low and middle income countries (LMICs) are just getting started with eHealth and decision support systems, but already pioneering projects are starting to have an impact in a range of environments and countries. One EHR system called OpenMRS is being used in over 50 developing countries, and there is initial evidence of clinical benefits from decision support systems deployed for HIV care in Kenya and Rwanda. Laboratory information systems have shown clinical benefits in Peru and Zambia, and there is some evidence of benefits from drug order entry systems. Cell phone-based mobile health or mHealth systems are increasingly being used to collect and deliver critical health data worldwide, with especial interest in LMICs. Initial results show evidence that mHealth can support better access to clinical data such as laboratory results, support community health care workers, and help HIV patients in Kenya to improve drug compliance. There is clear evidence that experience in the development and deployment of decision support systems in the US, UK and other high-income countries can be beneficial in LMICs, and also evidence especially for mhealth of benefits in both directions. This chapter reviews a range of projects in the UK and in a number of LMICs and discusses the lessons learned.