Division of Population Health Sciences 1 Royal College of Surgeons in Ireland Coláiste Ríoga na Máinleá in Éirinn Computer-Based Clinical Decision Support Systems (CDSSs) Borislav D Dimitrov

Division of Population Health Sciences 2 Contents 1) Clinical & Research Evidence: Implementation in Practice 2) Levels of Functionality in Health Informatics 3) Decision Support Systems (DSSs) 4) Clinical DSSs (computer-based / eCDSSs) 5) CPRs  EHR/EPR  eCDSSs: Better Decision-Making

Division of Population Health Sciences 3 I) Implementation of Evidence

Division of Population Health Sciences 4 II) Health Informatics – THE FUTURE Evolution of Functionality 1 Record keeping –Medical records –Patient scheduling –Appointments 2 Coding & prescribing –Morbidity coding –Drug prescribing –Drug interaction 3 Communication –Laboratory –Health professional & patient 4 Clinical knowledge –Clinical DSSs –Decision aids –Comparative clinical data

Division of Population Health Sciences 5 III) DSSs: definition and aspects - 1 Decision Support Systems (DSSs) - a class of computer-based information systems including knowledge-based systems that support decision-making activities: - parts/blocks: database/KB, model, user interface - components: inputs, user knowledge/expertise, outputs decisions - classifications: scope, relationships to user, mode of assistance, evolution, orientation

Division of Population Health Sciences 6 III) DSSs: examples - 2 Information Builders' WebFOCUS reporting software (DSS) Decision Support System (DSS) for John Day Reservoir

Division of Population Health Sciences 7 Clinical Decision Support Systems (CDSSs) – a direct aid to clinical decision-making in which the characteristics of an individual patient are matched to a computerized clinical knowledge base, and patient- specific assessments or recommendations are then presented to the clinician and/or the patient for a decision (Sim at al 2001) : - scope: designed ot improve clinical decision-making - key elements: integration with HER/EPR, computerised-knowledge base, algorithm, patient-specific info - classifications: context, knowledge & data source, decision support, information delivery, workflow IV) Clinical DSSs: definition and aspects - 1

Division of Population Health Sciences 8 IV) (Computer-based) eCDSS: example - 2

Division of Population Health Sciences 9 IV) eCDSS: example - 3 (CPR-based)

Division of Population Health Sciences 10 Increasing Healthcare Quality & Efficiency & Effectiveness Helping Clinical Decision-Making Process & Outputs  Translating Knowledge & Novel Evidence into Practice (WP3) International Register of CPRs  eCPRs  Integrated eCDSSs  Diagnostic Accuracy (  ) & Medical Errors (  ): Patient Safety (  ) EHR/RCTs  Repository of CPRs  eCDSSs (TRANSFoRm Project) V) Computer-Based (e)CDSSs - summary

Division of Population Health Sciences 11 Additional-1: Classifications of DSSs (taxonomy) Relationships to User: passive, active, cooperative Mode of Assistance [driven by]: communication, data, document, knowledge, model Scope: enterprise-wide, desktop Evolution [support to]: single-user/model-oriented  executive ISs, group DSSs, organizational DSSs Orientation [frameworks]: text, database, spreadsheet, solver, rule, compound (hybrid)

Division of Population Health Sciences 12 Scope: –Information systems are designed to improve clinical decision making Key elements: –Integration with EPR –Computerized knowledge base –Software algorithm –Provide patient-specific information Additional-2: Clinical DSSs

Division of Population Health Sciences 13 Additional-3: Clinical DSSs classifications (taxonomy) Context: setting, task, optimization, point-of-care, barriers to recommended action, external incentives Knowledge & Data Source: clinical source, update mechanism, data source, coding, customization Decision Support: reasoning method (e.g., CPR), recommendation explicitness, logistical complexity, clinical urgency, response, Information Delivery: format, mode, action integration, interactivity, explanations, Workflow: data input intermediary, user, DM target, output intermediary, degree of integration