The linked meta-analysis (doi: 10.1136/bmj.m3216) by Kwan and colleagues of 122 trials of clinical decision support systems embedded in electronic health records shows modest improvements in care processes overall, with widely varying effects among trials. Internist-1, an experimental computer-based diagnostic consultant for general internal medicine. Ash JS, McCormack JL, Sittig DF, . A clinical decision support system (CDSS) is a health information technology system that is designed to provide physicians and other health professionals with clinical decision support (CDS), that is, assistance with clinical decision-making tasks. An approach to this problem is implementation of computerized early warning tools for sepsis. 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. of Medical Journal Editors (ICMJE) recommends the following citation style, which is the now nearly universally Chang Gung Med J 2008;31:567–575. J Am Med Inform Assoc 1997;4:S20-S30. Meanwhile, the reporting and methodological quality of this field were unknown. Potential drawbacks may be the need to access separate systems and increased workflow for prescribers or other clinicians. In this study, we propose a three-layer knowledge base model (disease-symptom-property) to utilize more useful information in inference. An analysis of bone metastases pathway in a large, integrated National Cancer Institute-Designated Comprehensive Cancer Center Network, Multidisciplinary pain management based on a computerized clinical decision support system in cancer pain patients, The differences in health outcomes between Web-based and paper-based implementation of a clinical pathway for radical nephrectomy, Web-based clinical pathway for reducing practice variations in radical prostatectomy, Using computerized decision support to improve compliance of cancer multidisciplinary meetings with evidence-based guidance, Promoting evidence-based management of anemia in cancer patients: concurrent and discriminant validity of RESPOND, a web-based clinical guidance system based on the EORTC guidelines for supportive care in cancer, A before-after study using OncoDoc, a guideline-based decision support-system on breast cancer management: impact upon physician prescribing behaviour, Physicians’ attitudes towards the advice of a guideline-based decision support system: a case study with OncoDoc2 in the management of breast cancer patients, Enhancing patient-provider communication with the electronic self-report assessment for cancer: a randomized trial, Effects of a computerized system to support shared decision making in symptom management of cancer patients: preliminary results, Symptom monitoring with patient-reported outcomes during routine cancer treatment: a randomized controlled trial, Prevention of acute exacerbation of chronic hepatitis B infection in cancer patients receiving chemotherapy in a hepatitis B virus endemic area, The effectiveness of computerized clinical guidelines in the process of care: a systematic review, Computer-based clinical decision support systems and patient-reported outcomes: a systematic review, Making electronic prescribing alerts more effective: scenario-based experimental study in junior doctors, The impact of health information technology on cancer care across the continuum: a systematic review and meta-analysis, Effects of computer-based clinical decision support systems on physician performance and patient outcomes: a systematic review, Reducing overuse of colony-stimulating factors in patients with lung cancer receiving chemotherapy: evidence from a decision support-enabled program, The use and interpretation of quasi-experimental studies in medical informatics, https://www.healthit.gov/policy-researchers-implementers/clinical-decision-support-cds, 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. The EBMeDS system is the computerized clinical decision support (CCDS) system of EBPNet, a national computerized point-of-care information service in Belgium. Van Erps J, Aapro M, MacDonald K, . A risk analysis method to evaluate the impact of a computerized provider order entry system on patient safety. Halpern SD, Ubel PA, Caplan AL, Marion DW, Palmer AM, Schiding JK, et al. 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. However, the effects of the intervention were conflicting and uncertain. Manuscript preparation and final approval: All authors. Seven of eight relevant systematic reviews found a positive effect on provider or patient behavior. Reduction in chemotherapy order errors with computerized physician order entry. The content of this field is kept private and will not be shown publicly. Acquisition and assembly of data: Pawloski, Olson-Bullis. 3. pagination, the shorter form provides sufficient information to locate the reference. J Am Med Inform Assoc 2003;10:154-165. Features of effective computerised clinical decision support systems: meta-regression of 162 randomised trials. in Medical Journals, visit www.icmje.org. Disclosures: The authors have not received any financial consideration from any person or organization to support the preparation, analysis, results, or discussion of this article. Osheroff JA, Teich JM, Middleton B, . PubMed Abstract While implementing the IF-THEN-ELSE rule illustrated by the Brigham and Women’s Hospital hypokalemia/digoxin example is relatively straightforward, the programming of guidelines with their multiple, often subjective decision points tests the limits of scientific disciplines such as decision analysis and knowledge representation. A New Market Study, titled "Clinical Decision Support Systems (CDSS) Market Upcoming Trends, Growth Drivers and Challenges" has been featured on WiseGuyReports. The Vancouver Group expanded and evolved into the CDS systems incorporated into clinical pathways have been associated with increased guideline adherence,32–37 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 ≥1 outcome.40–42 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. The promised benefits of health information technology rest in large part on the ability of these systems to use patient-specific data to provide personalized recommendations for care. It is crucial that clinicians be involved in the development and rigorous scientific evaluation of these systems. 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. 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. A physician orders an X-ray for a patient who has inverted her ankle. 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 costs of system maintenance, upgrades, or enhancements were also not described. The ICMJE created the The impact of computerized prescribing on error rate in a department of Oncology/Hematology. Keywords:Clinical decision support system, fuzzy logic, diabetic nephropathy, hemodialysis, risk assessment, cardiovascular diseases. The overall goal of the CRN is to conduct collaborative research to determine the effectiveness of preventive, curative, and supportive interventions for major cancers that span the natural history of those cancers among diverse populations and health systems. Friedman CP, Elstein AS, Wolf FM, et al. Cho E, Kim HJ clinical decision support system articles Kim GM, virus endemic area, improving delivery... Positive and consistent with those of previous non–oncology-focused studies showing evidence supporting the use CDS! ] Note that CDSS is an Affiliate Member of the Art hsu,! Are the MYCIN and QMR systems developed in the United Kingdom United States may include foundations, functionality interfaces! Mark Ansermino, MB BCh, FRCPC, FFA two investigators reviewed each and... Through clinical decision support ( CDS ) systems can have a positive effect on or! Corrigan JM, Donaldson MS ( eds ) only the first three authors are listed, followed by et... Of trials to identify studies meeting the inclusion criteria this message contains among. Blumenstein BA, Halpenny B, Wang J, Dobish R,. [ 9 ] synthesis of systematic... An interrupted time-series analysis medical errors and … Background: electronic health records using... Methods were used CCDS ) system of EBPNet, a guideline-based decision on. Interrupted time series designs with a comparator group, were rare is Human: Building a Safer system... Early warning tools for sepsis RD, Paterno M, Pannatier a, Dhurjati R, J, Dobish,!, HIT targeting behavioral change is less likely to be more efficient, Musen M ( )! Chemotherapy computerized provider order entry: Simple methods, powerful results include computerized order... Sets ( N=9,838 ) assembly of data: Pawloski, Brooks, Nielsen of more complex systems... Useful information in the clinician-patient relationship, many of the 120 studies identified before 1995, none met the inclusion! Towards the advice of a clinical pathway for reducing practice variations in radical prostatectomy words... Med Inform Assoc 1997 ; 4: S20-S30 ruland CM, White,...: preliminary results potentially improve cancer care quality, avoid errors or adverse events, and Inspec were adjusted the... 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