Clinical decision support system paper

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Reply 1

Chelvi E

system (CDSS) is a computer-based program which analyzes data in a given electronic health record to provide reminders which helps the health care provider team in and guidelines for health care. Examples of CDSS could be like sending reminders to screen for any particular disease as a risk factor, flagging high levels of lab findings, giving well structured behavior changes for health wellness as stated in Centers for Disease Control and Prevention (2021, July).
Clinical decision support systems is a type of predictive analysis model where the inputs training the algorithm comes from the electronic health data. The Center for Medical and Medicare Services (CMS) will penalize the healthcare and hospitals for readmission for the same cause. So hospitals are motivated to go for such predictive models with a goal to reduce the number of preventable readmissions of already discharged patients, so more available data, the better the predictive models work (Magnuson et. al, 2020).

Some advantages of CDSS is that it helps in minimizing medical errors and increase the quality of healthcare and its efficiency which directly improves the clinical results with the additional help of evidence-based practice done on existing scientific evidence.Additionally, the CDSS system is also helpful to physicians in research and treatment. It provides alerts and help find the suitable and eligible patients for research based on specific medical or scientific criteria. This makes process easier in going to next steps on consent to contact, forward the patient chart amongst the research team.

Some drawbacks of the system include, scientific evidence may not be available and there may be few organizational data to get data and conclusions from. The current management environment changes rapidly leading to limitation of the clear and correct information which was generated in an organizational context that is not with current records or present state.
Lastly, an important disadvantage is that the practitioners need to keep updating with new skills in finding and appraising evidence which is time consuming and burns out the health care professional time (Center for Evidence-Based Managment, 2019).
As for nurses, they find the CDSS helps during drug administration thus improving patient safety. The organization system is updated with drug safety software like electronic drug dispensing systems (EDDS), bar-code point of care (BPOC) medication system which safeguards the dosage or duplication by referencing with patient information and prescription. This hugely helps in preventable errors happening in bedside (Sutton et al., 2020).It also helps nurses in lab work. For eg: The CDSS system automatically alerts the nurses to take glucose measurement based on the local glucose monitoring protocol which specifies how frequent measurement needs to be taken and to what kind of patients based on their demographics and previous glucose levels accordingly.
CDSS also assists with management of patients in treatment protocol and tracking their referrals along with preventative care which makes the process quicker for nurses. Several studies have shown how CDSS can help increase adherence to clinical guidelines as the traditional methods are tough to implement.

To conclude, CDSS helps nurses in preventing double checking their orders which were done before the implementation of this decision support system.

Reference

1. Centers for Disease Control and Prevention (2021, July).Implementing clinical decision support systems.https://www.cdc.gov/dhdsp/pubs/guides/best-practices/clinical-decision-support.htm
2. Sim, I., Gorman, P., Greenes, R. A., Haynes, R. B., Kaplan, B., Lehmann, H., & Tang, P. C. (2001). Clinical decision support systems for the practice of evidence-based medicine.Journal of the American Medical Informatics Association : JAMIA,8(6), 527534.https://doi.org/10.1136/jamia.2001.0080527

3. Center for Evidence-Based Management. (2019).What are the limitations of evidence based practice?.https://cebma.org/faq/limitations-evidence-based-practice/
4. Magnus, J., Dixon, B.E. (2020).Public health informatics and information systems (3rd ed).Springer.

posts 250-500 words)

Reply 2

Sincy Ab

DQ1: Physician
COLLAPSE
Clinical decision support system (CDSS) is defined as the use of information and communications technology (ICT) to bring relevant knowledge to bear on the health care and well-being of a patient (Dixon et al., 2020). The CDSS is an important component in health information exchange as they assist with interpretation, diagnosis, and treatments of patients (Khairat et al., 2018). Even though CDSS has many benefits such as reducing medical errors, it also comes with many shortfalls as well.
However, a successful clinical decision support system is one that will not overwhelm the physicians with unnecessary alerts to a point where fatigue sets in and CDS warning are ignored (Greenberg & Ridgely, 2011). A good system should also enable physicians to detect and prevent some medication adverse events that would otherwise go undetected: a result that inherently reduces liability for physicians (Greenberg & Ridgely, 2011). In other words, physicians will actually have a malpractice incentive, rather than a disincentive, to adopt good CDS system (Greenberg & Ridgely, 2011).
Many of the CDS systems we have in our health care systems are not successful due to the reason that they cause alert fatigue for physicians. This is a situation that can result in malpractice but more importantly bring harm to patients. The subject of alert fatigue and how to deal with it is a tough subject as it has different layers to it. From a standpoint of policy makers, the basic challenge is to ensure that liability concerns do not derail the clinical value of new CDS technology (Greenberg & Ridgely, 2011).
Studies have found that up to 95% of CDS alerts are inconsequential, and often times physicians disagree with or distrust alerts (Sutton et al., 2020). Disruptive alerts should be limited to more life-threatening or consequential contraindications such as serious allergies (Sutton et al., 2020). For example, an alert using broad-spectrum antibiotics such as vancomycin may be inappropriate in ICU. An alert against duplicate medications may be inappropriate in inflammatory bowel disease clinics, where the same class of drug can be applied through different administration routes for increased effect (Sutton et al., 2020).
CDS also suffers from interoperability issues. Many of the CDS system are created as stand-alone systems or exist in a system that cannot communicate effectively with other systems (Sutton et al., 2020). Also, many health organizations struggle financially as CDS is expensive to maintain. The outset costs to set up and integrate new systems can be substantial (Sutton et el, 2020). Besides that, the ongoing costs can continue to be an issue indefinitely as new staff needs to be trained on how to use the system, and system updates are required to keep pace with current knowledge (Sutton et al., 2020).
To conclude, the introduction of CDS has advanced the . But there are several downfalls with the system that needs to be taken into consideration as well.

References
Dixon B., Hadi K., Sridhar R. Papagari S. (2020)Public Health Decision Support Systems. In: Magnuson J., Dixon B.. (3rd)Public Health Informatics and Information Systems(pp.349-365). London, England: Springer.
Greenberg, M., & Ridgely, M. S. (2011). Clinical decision support and malpractice risk.JAMA,306(1).https://doi.org/10.1001/jama.2011.929
Khairat, S., Marc, D., Crosby, W., & Al Sanousi, A. (2018). Reasons for physicians not adopting clinical decision support systems: Critical Analysis.JMIR Medical Informatics,6(2).https://doi.org/10.2196/medinform.8912
Sutton, R. T., Pincock, D., Baumgart, D. C., Sadowski, D. C., Fedorak, R. N., & Kroeker, K. I. (2020). An overview of clinical decision support systems: Benefits, risks, and strategies for Success.Npj Digital Medicine,3(1).https://doi.org/10.1038/s41746-020-0221-y