Second Generation Clinical Support Systems – Certainly Part of The Way Forward!

The following article provides a very useful summary of the progress being made in Clinical Decision Support.

The supporting player: second generation CDS goes beyond the basics to become intuitive

Jonathan Teich

On a busy Friday night, a patient presented with shortness of breath in the emergency department (ED) at Boston's Brigham and Women's Hospital, where I serve as attending physician. After examining her, I immediately considered that she might have had a pulmonary embolus. I entered an order for a CT scan with intravenous contrast dye into the patient's electronic health record (EHR), but received a notice from the clinical decision support (CDS) system that the patient also suffered from renal failure and might experience kidney damage as a result of the intravenous dye.

Fortunately, the CDS system led me to information on how to use the drug Mucomyst to prevent this complication, and to an order set for correctly using Mucomyst. This second generation CDS system facilitated several important processes: It not only alerted me to a possible hazard, but also gave me information about what action I might take next, and helped me to execute that action.

CDS Evolution

Ask most IT professionals for a definition of CDS and they're likely to talk about alerts or warnings related to drug allergies or drug-drug interactions. For example, a physician who prescribes cephalexin (an antibiotic) discovers that the patient has a documented allergy to cephalosporins. The CDS system explains the concern and gives the clinician the option of canceling or continuing the order. These early forms of CDS--basic, single-factor, reactive alerts--are still valuable in a variety of clinical situations, particularly as immediate checks for errors related to prescribing and ordering.

But new and emerging second-generation CDS goes far beyond alerts. It infers possible questions and needs before they are explicitly asked, and it combines reference information seamlessly with tools for taking action. It embraces order sets, guideline helpers, problem-based documentation templates, just-in-time flowsheets and data displays, and intelligent integrated reference information. Such interventions can help to contain costs, control medical errors, boost clinical productivity and improve quality.

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CDS Innovation

Some of the most significant innovations in CDS belong to the category of referential or informational CDS. These features play a critical role in quality improvement and compliance programs. As healthcare IT professionals shop for EHRs and tools, they also need to shop for highly active CDS interventions with the potential to realize quality goals. Following are just some of the innovations IT professionals are likely to experience through second-generation CDS systems:

More here

http://www.healthmgttech.com/features/2008_february/0208_the_supporting.aspx

The attributes of the second generation systems discussed include:

1. Varying Depth for Varying Needs

2. Support of the Workflow

3. Infobuttons (or Knowledge-links)

4. Information Now and Later

5. Triggered Reference

6. Multimodal Reference

7. Two-factor Questions

8. Patient Access (to information).

The discussion of each of these and where they will fit in modern systems makes a very useful contribution and is well worth time spent reading.

David.

Note and Apology: The first Pulse + IT weekly news has been delayed by 24 hours – will be available by 11.00 am in Friday 13 June – Hope this bodes well for the future!

D.