Clinical decision support: effectiveness in improving quality processes and clinical outcomes and factors that may influence success

Elizabeth V Murphy, Elizabeth V Murphy

Abstract

The use of electronic health records has skyrocketed following the 2009 HITECH Act, which provides financial incentives to health care providers for the "meaningful use" of electronic medical record systems. An important component of the "Meaningful Use" legislation is the integration of Clinical Decision Support Systems (CDSS) into the computerized record, providing up-to-date medical knowledge and evidence-based guidance to the physician at the point of care. As reimbursement is increasingly tied to process and clinical outcomes, CDSS will be integral to future medical practice. Studies of CDSS indicate improvement in preventive services, appropriate care, and clinical and cost outcomes with strong evidence for CDSS effectiveness in process measures. Increasing provider adherence to CDSS recommendations is essential in improving CDSS effectiveness, and factors that influence adherence are currently under study.

Keywords: clinical decision support systems; clinical practice guidelines; computerized provider order entry; electronic health record; electronic medical records; meta-analysis of randomized controlled trials; preventive services guidelines; quality outcomes; quality process measure.

References

    1. Hsiao CJ, Hing E. NCHS Data Brief. Use and Characteristics of Electronic Health Systems Among Office-based Physician Practices: United States, 2001-2012. [accessed 15 Feb 2014];Centers for Disease Control and Prevention [Internet] 2012 December;111 Available from: .
    1. Osheroff JA, Teich JM, Middleton B, Steen EB, Wright A, Detmer DE. A Roadmap for National Action on Clinical Decision Support. J Am Med Inform Assoc. 2007;14(2):141–145.
    1. Kawamoto K, Jacobs J, Welch BM, Huser V, Paterno MD, Del Fiol G. et al. Clinical Information System Services and Capabilities Desired for Scalable, Standards-Based, Service-oriented Decision Support: Consensus Assessment of the Health Level 7 Clinical Decision Support Work Group. AMIA Annu Symp Proc. 2012:446–455.
    1. Weed LL. Medical Records that Guide and Teach. N Engl J Med. 1968;278(12):652–657.
    1. Greenes RA, Pappalardo AN, Marble CW, Barnett GO. Design and Implementation of a Clinical Data Management System. Comput Biomed Res. 1969;2(5):469–485.
    1. Fallon H, Goertzel G, Marler GE, Pulver RW. A Primer for Writing Medical Data Base for the Clinical Decision Support System. Prog Brain Res. 1970;33:155–175.
    1. McDonald CJ. Protocol-Based Computer Reminders, the Quality of Care and the Non-Perfectability of Man. N Engl J Med. 1976;295(24):1351–1355.
    1. Lobach D, Sanders GD, Bright TJ, Wong A, Dhurjati R, Bristow E. et al. Enabling Health Care Decisionmaking Through Clinical Decision Support and Knowledge Management. Evid Rep Technol Assess (Full Rep) 2012;(203):1–784.
    1. Litzelman DK, Dittus RS, Miller ME, Tierney WM. Requiring Physicians to Respond to Computerized Reminders Improves Their Compliance with Preventive Care Protocols. J Gen Intern Med. 1993;8:311–317.
    1. Demakis JG, Beauchamp C, Cull WL, Denwood R, Eisen S, Lofgren R. et al. Improving residents’ compliance with standards of ambulatory care: results from the VA Cooperative Study on Computerized Reminders. JAMA. 2000;284(11):1411–1416.
    1. Dexter PR, Perkins S, Overhage JM, Maharry K, Kohler RB, McDonald CJ. A Computerized Reminder System to Increase the Use of Preventive Care in Hospitalized Patients. N Engl J Med. 2001;345(13):965–970.
    1. Feldstein A, Elmer PJ, Smith DH, Herson M, Orwoll E, Chen C. et al. Electronic Medical Record Reminder Improves Osteoporosis Management after a Fracture: A Randomized Controlled Trial. J Am Geriatr Soc. 2006;54(3):450–457.
    1. Kucher N, Koo S, Quiroz R, Cooper JM, Paterno MD, Soukonnikov B. et al. Electronic Alerts to Prevent Venous Thromboembolism in Hospitalized Patients. N Engl J Med. 2005;352(10):969–977.
    1. Haut ER, Lau BD, Kraenzlin FS, Hobson DB, Kraus PS, Carolan HT. et al. Improved Prophylaxis and Decreased Rates of Preventable Harm With the Use of a Mandatory Computerized Clinical Decision Support Tool for Prophylaxis for Venous Thromboembolism in Trauma. Arch Surg. 2012;47(10):901–907.
    1. Burack RC, Gimotty PA, George R, Simon MS, Dews P, Moncrease A. The Effect of Patient and Physician Reminders on the Use of Screening Mammography in a Health Maintenance Organization. Cancer. 1994;78(8):1708–1721.
    1. Fiks AG, Hunter KS, Localio AR, Grundmeier RW, Bryant-Stephens T, Luberti AA. et al. Impact of Electronic Health Record-Based Alerts on Influenza Vaccination in Children with Asthma. Pediatrics. 2009;124(1):159–169.
    1. Heidenreich PA, Gholami P, Sahay A, Massic B, Goldstein MK. Clinical Reminders Attached to Echocardiography Reports of Patients with Reduced Left Ventricular Ejection Fraction Increase Use of β-Blockers: a Randomized Trial. Circulation. 2007;115:2829–2834.
    1. Paul M, Andreassen S, Tacconelli E, Nielsen AD, Almanasreh N, Frank U. et al. Improving empirical antibiotic treatment using TREAT, a computerized decision support system: cluster randomized trial. J Antimicrob Chemother. 2006;58:1238–1245.
    1. Overhage JM, Tierney WM, Zhou XH, McDonald CM. A Randomized Trial of “Corollary Orders” to Prevent Errors of Omission. J Am Med Inform Assoc. 1997;4:364–375.
    1. Field TS, Rochon P, Lee M, Gavendo L, Maril JL, Gurwitz JH. Computerized Clinical Decision Support During Medication Ordering for Long-term Care Residents with Renal Insufficiency. J Am Med Inform Assoc. 2009;16(4):480–485.
    1. McCowan C, Neville RG, Ricketts IW, Warner FC, Hoskins G, Thomas GE. Lessons from a randomized controlled trial designed to evaluate computer decision support software to improve the management of asthma. Med Inform. 2001;26(3):191–201.
    1. Bell LM, Grundmeier R, Localio R, Zorc J, Fiks AG, Zhang X. et al. Electronic Health Record-Based Decision Support to Improve Asthma Care: A Cluster-Randomized Trial. Pediatrics. 2010;125:e770–e777.
    1. Khan S, Maclean CD, Littenberg B. The effect of the Vermont Diabetes Information System on inpatient and emergency room use: results from a randomized trial. Health Outcomes Res Med. 2010;1(1):e61–e66.
    1. Quinn CC, Shardel MD, Terrin ML, Barr EA, Ballew SH, Gruber-Baldini AL. Cluster-Randomized Trial of a Mobile Phone Personalized Behavioral Intervention for Blood Glucose Control. Diabetes Care. 2011;34:1934–1942.
    1. Bright TJ, Wong A, Dhurjati R, Bristow E, Bastian L, Coeytaux RR. et al. Effect of Clinical Decision Support Systems: A Systematic Review. Ann Intern Med. 2012;157(1):29–43.
    1. Kawamoto K, Houlihan CA, Balas EA, Lobach DF. Improving clinical practice using clinical decision support systems : a systematic review of trials to identify features critical to success. BMJ. 2005;330(7494):765.
    1. Roshanov PS, Fernandes N, Wilczynski JM, Hemens BJ, You JJ, Handler SM. et al. Features of effective computerized clinical decision support systems: meta-regression of 162 randomised trials. BMJ. 2013;346:f657.
    1. Cabana MD, Rand CS, Powe NR, Wu AW, Wilson MH, Abboud PC. et al. Why Don’t Physicians Follow Clinical Practice Guidelines, A Framework for Improvement. JAMA. 1999;282(15):1458–1465.
    1. Lobach DF. The road to effective clinical decision support: are we there yet? BMJ. 2013;346:f1616.
    1. Bates DW, Kuperman GJ, Wang S, Gandhi T, Kittler A, Volk L. et al. Ten Commandments for Effective Clinical Decision Support: Making the Practice of Evidence-Based Medicine a Reality. J Am Med Inform Assoc. 2003;10(6):523–530.
    1. Sirajuddin AM, Osheroff JA, Sittig DF, Chuo J, Velasco F, Collins DA. et al. Implementation Pearls from a New Guidebook on Improving Medication Use and Outcomes with Clinical Decision Support. J Healthc Inf Manag. 2009;23(4):38–45.

Source: PubMed

3
Abonnieren