Clinical Decision Support Systems

Computer-based clinical decision support (CDS) can be explained as the use of information and communication technologies to bring relevant knowledge to bear on the health care and wellbeing of a patient. Features of CDS:

First. The general aim of CDS can be one or both of the following:

• To make data about a patient easier to assess by, or more apparent to, a human.
• To foster optimal problem solving, decision making, and action by the human. The exact nature of a particular form of CDS depends on its specific purpose.

Second. The decision support is provided to a user – who may be a physician, a nurse, a laboratory technologist, a pharmacist, a patient, or other individual with a need for it. In some instances, the user may be a computer program rather than a human user. Many possible settings can give rise to the need for CDS, such as a problem arising in clinical practice, a health maintenance/ preventive care question of a patient, or a training/educational exercise.

Third. A primary task of the computer is to select or group knowledge that is pertinent, and/or to process data to create the pertinent knowledge. To the extent that the computer can make the selection based on patient-specific data, the relevance of the CDS to the individual patient is enhanced.

Forth.The selection or grouping of knowledge and processing of data involve carrying out some sort of inferencing process, algorithm, rule, or association method.

Fifth. The result of CDS is to perform some action, usually to make a recommendation. In some forms of CDS the action is implicit. A rule with an if and a then part is a form of CDS that has an explicit action, in the then part. An order set is a form of CDS that groups information that has an association, e.g. a set of orders that might be needed for a particular problem or indication. In this case, the action is that of assembling the individual items in the order set for presentation and consideration by the user. Another major form of CDS is a documentation template – either for input of data into structured forms or producing a report based on structured data elements. The action involved in using a documentation template for CDS is that of assembling the data elements needed for particular contexts in the document, either in an input form or for presentation–such as describing the characteristics of abdominal pain.

The need for Clinical Decision Support Systems

Patient safety is universally recognized as important clinical topic in healthcare. On the opposite the hospitals are struggling with limited resources and increasing patient activity.

Medical advancements allow people to live longer, often with the consequences of multiple chronic illnesses and a lengthened recovery period. Even more in some countries there is a shortage of clinicians, leaving nursing positions in hospitals unfilled. This leads to inexperienced and unqualified staff even in the critical care areas. To address these deficiencies in care, healthcare organizations are increasingly turning to Clinical Decision Support Systems (CDSS), which provide clinicians with patient-specific evaluation or commendations to aid clinical decision making. CDSS have shown promise for reducing medical errors and improving patient care.

Important criteria for a clinically useful CDSS are:

1. Data actively used drawn from existing sources
2. System improves clinical practice
3. Knowledge based on best evidence
4. Knowledge fully covers problem
5. Clinician can control system
6. The system is easy to use
7. The system can be configured and updated
8. The decisions made are transparent

Clinical Decision System play important role Clinical consultation for doctors and nurses. Reminders, alerts and advisories draw on all the data in the chart labs, monitoring, calculations, to provide early warning of potentially serious conditions. The available data for clinical advisories contains:

1. Patient monitoring data
2. Third-party devices (bedside monitors, ventilators, infusion pumps, etc.)
3. Images (ultrasound, x-ray, CT, MR)
4. Lab results (blood tests, urinalysis)
5. Pharmacy – drug/drug interactions, dosing guidelines, Computer Physician Order Entry (CPOE), Medical Administration Record (MAR).
6. Patient demographics and medical histories
7. Documentation of patient care process, e.g. assessments and intervention

Clinical Decision Systems for dentists

Clinical Decision Systems also consultation for dentists as Dental Clinics. Benefits of Decision Support Systems in Dental Clinics: Besides assisting dentists to make timely and informed treatment decisions, a DSS is also useful in the following areas:

1. keeping electronic health records (EHR)
2. drug prescription, medication dosing support
3. clinical reference count
4. point-of-care alerts and reminders

Maryam Ghalandari