Published reports in the peer-reviewed literature were identified, and all abstracts were reviewed for eligibility. The advances in mHealth such as data analytics and algorithm development based on continuous capture of a wide range of structured and unstructured patient-related data, can be harnessed to address such uncertainties through a Clinical Decision-Support System (CDSS) [12, 13], a software that can aid clinical decision making through careful matching of the patient individual factors (e.g., … Enabling health care decisionmaking through clinical decision support and knowledge management. Basch E, Deal AM, Kris MG, . The types of CDSS available are as broad as human ingenuity allows: from personal digital assistant applications customized by a single clinician to multihospital mainframe-based surveillance systems meant to assure care for thousands of patients. Clinical decision support system (CDSS) is an interactive software which is developed on the basis of expert systems in order to assist and support the decision-making of physicians, health-care staff, and other personnel involved in broader domains of health-care systems. Provision of study materials: Olson-Bullis. The ICMJE created the J Oncol Pract 2011;7:218â222. Clinical decision support (CDS) systems include any electronic system designed to directly aid clinical decision-making by using individual patient characteristics to generate patient-specific assessments or recommendations. Rockville, MD: Agency for Healthcare Research and Quality; 2009. 4. However, research has shown that none of these CDSSs are capable of differentiating among primary headaches with overlapping features. Clin Transl Oncol 2006;8:821â825. Ottawa: National Steering Committee on Patient Safety, 2002. CDS systems with all 4 features were associated with significant improvements in clinical practice. National Library of Medicine (NLM), were first published in 1979. Evid Rep Technol Assess (Full Rep) 2012;203:1â784. While in experimental tests the system could be as good as a panel of clinicians, MYCIN was never widely used because of difficulties with maintenance and incorporating the system into a clinician’s workflow. Dr Ansermino is a member of the Centre for Health Innovation and Improvement (CHIi) and a pediatric anesthesiologist at BC’s Children’s Hospital. There is no period after the journal name. Bouaud J, SÃ©roussi B, Antoine EC, . PubMed Abstract Shortliffe EH, Davis R, Axline SG, et al. Opportunities for a better use of healthcare resources. CPOE showed a small impact on provider behavior, with general alerts and increased pharmacist order review times. Meaningful community collaboration in research, Non-adherence to public health recommendations: Call the psychotherapists, Beyond the day-to-day practice of medicine, Green: The most suitable color for hospital textiles, Updates to BC Cancer Cervix Screening affecting primary care, Geriatric depression: The use of antidepressants in the elderly, Changes to medical staff privileging in British Columbia, Timing of return to work after hernia repair: Recommendations based on a literature review. Reducing overuse of colony-stimulating factors in patients with lung cancer receiving chemotherapy: evidence from a decision support-enabled program. However, the effects of the intervention were conflicting and uncertain. This multicenter retrospective study sought to determine clinimetric performance of a cloud-based computerized sepsis clinical decision support system (CDS), understand the epidemiology of sepsis, and identify opportunities for quality improvement. Robust quasi-experimental study designs, such as interrupted time series designs with a comparator group, were rare. Hripcsak GH. National Steering Committee on Patient Safety. In: van Bemmel J, Musen M (eds). This report provides in … AHRQ Publication No. Physician order entry: a mixed blessing to pharmacy? In this paper, we investigate the performance of a clinical decision-support system (CDSS) that had been previously built and validated internally. The types of CDSS available are as broad as human ingenuity allows: from personal digital assistant applications customized by a single clinician to multihospital mainframe-based surveillance systems meant to assure care for thousands of patients. The areas addressed may include foundations, functionality, interfaces, implementation, impacts, and evaluation of decision support systems (DSSs). Arch Intern Med 2003;163:1409â1416. Designing good evaluative trials is difficult and the sheer variety of systems and functions makes comparison complicated. The use and interpretation of quasi-experimental studies in medical informatics. Patkar V, Acosta D, Davidson T, . Key features that appear to support positive outcomes include real-time information and point-of-care action. Computerized provider order entry in pediatric oncology: design, implementation, and outcomes. JAMA 2005;293:1223â1238. The International Committee After review and screening of titles and abstracts, 83 full-text articles were assessed for eligibility, and 24 studies were included in the final analysis. Relevant narrative reviews, systematic reviews, and meta-analyses were also evaluated for background information, but were not included in this study. Heidelberg: Springer-Verlag, 1997:261-276. N Engl J Med 1980;303:192-197. Thus, CDS has the potential to drive evidence-based standardization of cancer care, improving care delivery and patient outcomes. Acquisition and assembly of data: Pawloski, Olson-Bullis. Only the first three authors are listed, followed by "et al.". Within the CDS systems, key factors that appear to contribute to improved outcomes include the use of real-time provider alerts and point-of-care action on prescription orders and provision of information to clinicians that CDS systems can provide.20,27,32,36,37,40â42 There appear to be resulting factors that create new challenges, such as the need to access separate systems and otherwise increase work time of prescribers or other downstream clinicians, that may reduce outcomes.21,26,34,35. The complexity of diagnosis and treatment, the volume of information needed, and the factors associated with behavior change were given as potential reasons for these findings. When integrated with a computerized physician order entry (CPOE), CDSSs can guide a physician’s decisions during the process of entering medication orders or other physicians’ instructions. Potential drawbacks may be the need to access separate systems and increased workflow for prescribers or other clinicians. . The NLM now lists all authors. An analysis of bone metastases pathway in a large, integrated National Cancer Institute-Designated Comprehensive Cancer Center Network. Inclusion/exclusion criteria were determined a priori. Clinical decision support systems. Harris AD, McGregor JC, Perencevich EN, . Improving clinical practice using clinical decision support systems: a systematic review of trials to identify features critical to success. Stud Health Technol Inform 2001;84:420â424. A more recent Canadian report called for investment in information-technology infrastructures that support the standardized identification, reporting, and tracking of patient safety data. This systematic review assessed evidence supporting the use of CDS systems in cancer care delivery from studies evaluating cancer diagnosis, treatment, and supportive care. Halpern SD, Ubel PA, Caplan AL, Marion DW, Palmer AM, Schiding JK, et al. HealthPartners Institute is an Affiliate Member of the HCS Research Network. CDS systems incorporated into clinical pathways have been associated with increased guideline adherence,32â37 demonstrating the benefit they can provide to clinicians, and consistent with findings of previous systematic reviews also showing a positive impact on guideline adherence.10,44 Three studies included in our analysis evaluated the use of CDS systems for PROs, and all demonstrated benefit for â¥1 outcome.40â42 These findings differ somewhat from those of a systematic review of 15 studies that assessed the effect of CDS systems on PROs, which showed a positive effect on symptoms in 3 studies (20%).45 A CDS system used with prescriber alerts demonstrated a positive impact, which is consistent with findings of a previous study.43,46, The findings are also consistent with those of a meta-analysis assessing the impact of health information technology (HIT) on cancer care from 2000 to June 2014.47 CDS systems were the most common (66%) HIT intervention identified and were implemented across several cancer types, including breast, colorectal, and prostate, for detection, diagnosis, and treatment but not for survivorship or end-of-life care. Such systems have been shown to decrease inappropriate X-ray orders by as much as 47%.. Available at: https://joinup.ec.europa.eu/sites/default/files/document/2014-12/eHealth%20for%20a%20Healthier%20Europe%20-%20Opportunities%20for%20a%20better%20use%20of%20healthcare%20resources.pdf. However, there is a critical need to rigorously evaluate CDS systems in oncology to better understand how they can be implemented to improve patient outcomes. Chang PL, Li YC, Lee SH. MYCIN was developed in the 1970s to help clinicians choose antibiotics for bacteremia or meningitis. Our systematic review is reported >10 years after a call to action by the AMIA regarding the use of CDS.4 The call included directives for achieving desirable levels of patient safety, care quality, patient-centeredness, and cost-effectiveness. A major gap in CDS system use exists across the spectrum of clinical oncology care, and further development of CDS tools is warranted. Table 2 describes individual study sample sizes, study design, number of facilities, and diagnoses, and supplemental eTable 1 summarizes the objectives and outcomes of each included study. The question is surprisingly hard to answer. Diabetes systems might be the best example of cases where patient-specific data, such as blood glucose measurements and food intake, are used to generate customized educational modules and detailed dietary recommendations. J Clin Oncol 2016;34:557â565. One study evaluated prescriber alerts with CDS tools and demonstrated that hard stops for hepatitis B screening before chemotherapy treatment were associated with increased screening (99.3% vs 40.2%; PP43. Do clinical decision support systems improve patient care? Health care organizations are turning to electronic clinical decision support systems (CDSSs) to increase quality of patient care and promote a safer environment. J Clin Bioinforma 2015;5:4. Most studies used an uncontrolled, pre-post intervention design. Similar CPOE systems can be successful in a wide variety of settings, with some of the most compelling uses being the prevention of drug dose and interaction errors. The purpose of this article is to perform a systematic review over the past 5 years on the role and effectiveness of clinical decision support systems (CDSSs) on antibiotic stewardship. For optimal retrieval, all terms were supplemented with relevant title and text words. Results: Electronic database searches yielded 2,439 potentially eligible papers, with 24 studies included after final review. Electronic clinical decision support (CDS) systems can potentially improve cancer care quality and safety. Moher D, Liberati A, Tetzlaff J, . Health Inf Manag 2015;44:13â22. In: Shortliffe EH, Perrault L, Wiederhold G, et al. The study team made every effort to identify all publications meeting the inclusion criteria. 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