9. U.S. National Library of Medicine. Effect of clinical decision-support systems: a systematic review. The ICMJE is small group of editors of general medical journals who first met informally in Vancouver, British Columbia, The Arden Syntax is a quasi-programming language that allows the encoding of decision rules into a computer-readable format. Scott GP, Shah P, Wyatt JC, . Key features that appear to support positive outcomes include real-time information and point-of-care action. eHealth for a Healthier Europe! Evid Rep Technol Assess (Full Rep) 2012;203:1â784. in 1978 to establish guidelines for the format of manuscripts submitted to their journals. 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. Designing good evaluative trials is difficult and the sheer variety of systems and functions makes comparison complicated. These are all crucial elements that must be assessed and understood for optimal implementation to occur. Common roles for CDS include computerized physician order entry (CPOE) and electronic health record (EHR) clinical reminder systems.2. Mattsson TO, Holm B, Michelsen H, . 2011; 18(3): 327-334. The Vancouver Group expanded and evolved into the Background: Electronic health records are central to cancer care delivery. (eds). Peer-reviewed studies published from 1995 through 2016 were included if they assessed clinical outcomes, patient-reported outcomes (PROs), costs, or care delivery process measures. Bibliographies from selected key articles, relevant review articles, and related meta-analyses were reviewed to identify additional publications. Beriwal S, Rajagopalan MS, Flickinger JC, . A clinical decision support system (CDSS) is a system designed to support clinical decisions during a diagnostic or therapeutic care process. Making electronic prescribing alerts more effective: scenario-based experimental study in junior doctors. N Engl J Med. 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. Cho E, Kim HJ, Kim GM, . Medical decision support: Experience with implementing the Arden Syntax at the Columbia-Presbyterian Medical Center. pagination, the shorter form provides sufficient information to locate the reference. 09-0069-EF. Seven of eight relevant systematic reviews found a positive effect on provider or patient behavior. BMC Health Serv Res 2010;10:2. These studies demonstrated a positive impact on prescriber errors, safety events, and workflow.20â31 CDS tools implementing clinical pathways,32â37 CPGs,38,39 PROs,40â42 and prescriber alerts43 were also primarily associated with positive outcomes, including reduced hospital stays,35 increased guideline use and concordance,33,38,39 enhanced identification of trial-eligible patients,36 and improvements in symptom management.41 Overall, the studies suggest that clinical oncologyâfocused CDS systems appear to be well accepted and are associated with potentially meaningful improvements in patient care. Int J Qual Health Care 2011;23:36â43.  Reflecting the changing locus of control in the clinician-patient relationship, many of the systems are designed expressly for the patient. J Oncol Pract 2014;10:e5â9. . The total number of CDS systems that have been studied, had no outcome improvement, and were subject to publication bias is unknown. Currently available data suggest that these systems can have a positive impact on the quality of cancer care delivery. Available at: . The ICMJE created the 8. The question is surprisingly hard to answer. Assessment of efficiency and safety of the comprehensive Chemotherapy Assistance Program for ordering oncology medications. Jenders RA, Hripcsak G, Sideli RV, et al. PubMed Abstract Full Text , Consider the following example from the Brigham and Women’s Hospital: A hospital laboratory technician runs an electrolyte panel on a sample of blood from a patient. This systematic review assessed evidence supporting the use of CDS systems in cancer care delivery from studies evaluating cancer diagnosis, treatment, and supportive care. However, the labor-intensive, often biased process of entering findings limits its utility. Journal of the National Comprehensive Cancer Network J Natl Compr Canc Netw, Enabling health care decisionmaking through clinical decision support and knowledge management, Clinical decision support systems for improving diagnostic accuracy and achieving precision medicine, A roadmap for national action on clinical decision support, Standard practices for computerized clinical decision support in community hospitals: a national survey, The development of primary care information technology in the United Kingdom, Features of effective computerised clinical decision support systems: meta-regression of 162 randomised trials, Improving clinical practice using clinical decision support systems: a systematic review of trials to identify features critical to success, Effects of computerized clinical decision support systems on practitioner performance and patient outcomes: a systematic review, Systematic review: impact of health information technology on quality, efficiency, and costs of medical care, A risk analysis method to evaluate the impact of a computerized provider order entry system on patient safety, Effects of computerized physician order entry and clinical decision support systems on medication safety: a systematic review, Effect of clinical decision-support systems: a systematic review. Clinical Decision Support Systems (CDSS) are considered essential tools of evidence-based medicine. Enhancement of clinicians’ diagnostic reasoning by computer-based consultation: A multisite study of two systems. J Am Med Inform Assoc 2003;10:573â579. Although CDSSs have been shown to reduce medical errors and … Published studies of CDS systems are largely associated with positive outcomes, and their findings consistent with those of studies conducted in the noncancer population. ClinicalTrials.gov. in Medical Journals, visit www.icmje.org. 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., … To optimize care pathways with an intelligent decision support system aimed at facilitating diagnosis and therapeutic decisions along disease-specific pathways.  The two most famous examples are the MYCIN and QMR systems. Of the 120 studies identified before 1995, none met the predefined inclusion criteria and therefore they were not included in this analysis. A large part of any physician’s work, especially in non-procedural disciplines, involves acquiring information and then, aided by evidence and experience, making decisions for the best possible outcome. 09-0069-EF. Medical Journals It does this by using a large database of “evoking strengths,” “importance,” and “frequencies” of findings seen in diseases within its domain. Recommendations for the Conduct, Reporting, Editing, and Publication of Scholarly Work in PubMed Abstract Full Text Castaneda C, Nalley K, Mannion C, . 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 objective of this paper is to introduce a high level reference model that is intended to be used as a foundation to design successful and contextually relevant CDSS systems. Tarver WL, Menachemi N. The impact of health information technology on cancer care across the continuum: a systematic review and meta-analysis. Computer technology can assist by generating case-specific advice for clinical decision making. Dr Ansermino is a member of the Centre for Health Innovation and Improvement (CHIi) and a pediatric anesthesiologist at BC’s Children’s Hospital.  The program takes historical and physical findings and generates a differential diagnosis. Multidisciplinary pain management based on a computerized clinical decision support system in cancer pain patients. Provision of study materials: Olson-Bullis. The systems used are usually referred to as clinical decision support systems or CDSS. Clinical Decision Support Systems: State of the Art. Systematic review: impact of health information technology on quality, efficiency, and costs of medical care. In earlier days, this whole process could take place in the brain of the practitioner. Two systematic reviews that assessed CPOE for inpatients in medicine or intensive care units12 and at the point of care in any clinical setting13 demonstrated a clear benefit to implementing CDS. How effective are clinical pathways with and without online peer-review? Collins CM, Elsaid KA. In this study, we propose a three-layer knowledge base model (disease-symptom-property) to utilize more useful information in inference. When the order is entered into the computer, the physician is reminded of the exact elements of the evidence-based criteria for such an order (the Ottawa Ankle Rules). Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement, Reduction in chemotherapy order errors with computerised physician order entry and clinical decision support systems. Patkar V, Acosta D, Davidson T, . This report provides in … 2002;347:284-7. Meanwhile, the reporting and methodological quality of this field were unknown. Most studies used an uncontrolled, pre-post intervention design. BJU Int 2002;90:522â528. 4. CPOE refers to a variety of computer-based systems for ordering medications or tests. However, little is known regarding the use of CDS systems in clinical oncology and their impact on patient outcomes. Results: Electronic database searches yielded 2,439 potentially eligible papers, with 24 studies included after final review. 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, one study did not demonstrate favorable findings, and some of the findings were not of significant magnitude.28 Overall, these data demonstrate the potential value that CDS systems can bring to oncology clinical practices. In a manner consistent with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement, we conducted a comprehensive review of the clinical and scientific literature.19 A trained health sciences librarian (B.A.O.B.) PubMed Abstract Basch E, Deal AM, Kris MG, . As today’s healthcare delivery system continues to accelerate and evolve key stakeholders from hospital executives to clinicians, are faced with a growing number of challenges in the enabling and sustaining of outcomes-based healthcare. 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. It is crucial that clinicians be involved in the development and rigorous scientific evaluation of these systems. Kaushal R, Shojania KG, Bates DW. Clinical decision support through an electronic health record has been proposed as a promising approach to improving guideline-based care. The use of CDSSs to facilitate evidence-based medicine therefore promises to substantially improve health care quality. 3. BMJ 2005;330:765. Musen M, Shahar Y, Shortliffe EH. There is a critical need for CDS systems development and well-designed studies to demonstrate improvement in patient outcomes, including impact on survival and efficiency of cancer care delivery. Impact of electronic chemotherapy order forms on prescribing errors at an urban medical center: results from an interrupted time-series analysis. Washington, DC: National Academy Press, 1999. In this article, the advantages, potential drawbacks, and clinical decision support system adoption barriers are discussed, followed by an in-depth review of the characteristics that make a clinical decision support system successful. For articles that met all inclusion criteria, two investigators independently extracted the following information: clinical setting, participants, methodological details, characteristics of the design and content of the clinical decision support system, presence of educational and non-educational co-interventions, and outcomes. Ash JS, McCormack JL, Sittig DF, . 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. A roadmap for national action on clinical decision support. Improving modern cancer care through information technology, Delivering High-Quality Cancer Care: Charting a New Course for a System in Crisis. 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.  Note that CDSS is an integral part of this system, alongside laboratory, radiology, and health records. Electronic database searches yielded 2,439 potentially eligible papers (Figure 1). The BC Medical Journal is a general medical journal published by Doctors of BC. Above is the information needed to cite this article in your paper or presentation. Huertas FernÃ¡ndez MJ, Baena-CaÃ±ada JM, MartÃnez Bautista MJ, . 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. These types of systems are in use today.. Hanauer DA, Zheng K, Commiskey EL, . Levit L, Balogh E, Nass S, Ganz PA, eds. International Committee of Medical Journal Editors (ICMJE), which meets annually. J Am Med Inform Assoc 2003;10:94-107. Effects of computerized physician order entry and clinical decision support systems on medication safety: a systematic review. Effects of clinical decision-support systems on practitioner performance and patient outcomes: a synthesis of high-quality systematic review findings. A solution to this challenge is multifactorial decision support systems (DSSs), continuously learning artificial intelligence platforms that integrate all available data—clinical, imaging, biologic, genetic, cost—to produce validated predictive models. Ruland CM, White T, Stevens M, . An analysis of bone metastases pathway in a large, integrated National Cancer Institute-Designated Comprehensive Cancer Center Network. CONSORT diagram of studies showing evidence supporting the use of electronic clinical decision support (CDS) systems in cancer care. Databases searched were: PubMed, Embase, Academic Search Premier, Web of Science, and Inspec. Full Text Computerized provider order entry in pediatric oncology: design, implementation, and outcomes, Assessment of efficiency and safety of the comprehensive Chemotherapy Assistance Program for ordering oncology medications, Using an enhanced oral chemotherapy computerized provider order entry system to reduce prescribing errors and improve safety, Impact of electronic chemotherapy order forms on prescribing errors at an urban medical center: results from an interrupted time-series analysis, Computerized prescriber order entry implementation in a physician assistant-managed hematology and oncology inpatient service: effects on workflow and task switching, Impact of computerised chemotherapy prescriptions on the prevention of medication errors, Non-intercepted dose errors in prescribing anti-neoplastic treatment: a prospective, comparative cohort study, Reduction in chemotherapy order errors with computerized physician order entry, The impact of computerized prescribing on error rate in a department of Oncology/Hematology, Effect of computerisation on the quality and safety of chemotherapy prescription, How effective are clinical pathways with and without online peer-review? Physiciansâ attitudes towards the advice of a guideline-based decision support system: a case study with OncoDoc2 in the management of breast cancer patients. Qual Saf Health Care 2006;15:418â421. A broad range of information systems can now generate patient-specific advice to aid clinical decision making. Hsu PI, Lai KH, Cheng JS, . Int J Qual Health Care 2013;25:656â663. To date, few studies have evaluated CDS systems in oncology practice. Am J Prev Med 2011;40(5 Suppl 2):S198â207. It provides continuing medical education with a focus on evidence-based medicine. Clinical Decision Support. Medical Informatics: Computer Applications in Health Care and Biomedicine. Clinical Decision Support Systems: State of the Art. A recent review of 57 randomized controlled trials and 10 systematic reviews evaluated the effectiveness of computer-based delivery of health evidence, including CDSS. Elsaid K, Truong T, Monckeberg M, . The study team made every effort to identify all publications meeting the inclusion criteria. The clinical decision support system(CDSS) has potential to improving medication safety. Ann Intern Med 2006;144:742â752. AHRQ Publication No. Shortliffe EH, Davis R, Axline SG, et al. CDS tools have been incorporated across the patient care spectrum, encompassing prevention, diagnosis, and clinical monitoring. A 1999 report from the Institute of Medicine, revealed the magnitude of ongoing medical error, documenting as many as 7000 annual deaths in the US due to medication errors in hospitals. Bertsche T, Askoxylakis V, Habl G, . 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. Disease management systems are specialized CDSS that help clinicians and patients negotiate complex treatment algorithms for conditions such as asthma, hypertension, diabetes, and hyperlipidemia. Proc Annu Symp Comput Appl Med Care 1995:169-173. Potential drawbacks may be the need to access separate systems and increased workflow for prescribers or other clinicians. J Am Med Inform Assoc 2012;19:980â987. Mark Ansermino, FFA, MMed, MSc, FRCPC, Recommendations for the Conduct, Reporting, Editing, and Publication of Scholarly Work in Health Inf Manag 2015;44:13â22. , The QMR system uses an ingenious algorithm modeled on the clinical reasoning of a single University of Pittsburgh internist. They assist with interpretation, diagnosis, and treatment. Improving clinical practice using clinical decision support systems: a systematic review of trials to identify features critical to success. Delivering High-Quality Cancer Care: Charting a New Course for a System in Crisis. The use of computers for clinical care: A case series of advanced US sites. A pathognomonic finding has a high evoking strength while a finding commonly seen in a given disease also increases the weighting given to that disease in the differential diagnosis. Full PubMed search parameters are available in supplemental eAppendix 1 (available with this article at JNCCN.org). It is worth noting, however, that this review excluded computer-generated reminders. Effect of computerisation on the quality and safety of chemotherapy prescription. Available at: https://www.healthit.gov/policy-researchers-implementers/clinical-decision-support-cds. Hunt DL, Haynes RB, Hanna SE, . Automating complex guidelines for chronic disease: Lessons learned. The development of clinical decision support systems (CDSSs) for the diagnosis of primary headaches has long been a major research topic. Nonetheless, there are numerous examples of computerized guidelines in use today.. to save searches and organize your favorite content. Computer-based consultations in clinical therapeutics: Explanation and rule acquisition capabilities of the MYCIN system. The remaining studies examined oncology clinical pathways, guideline adherence, systems for collection and communication of PROs, and prescriber alerts. Improving modern cancer care through information technology. The areas addressed may include foundations, functionality, interfaces, implementation, impacts, and evaluation of decision support systems (DSSs). IAIMS architecture.  The clinicians would enter a series of facts about history, physical findings, and laboratory results into the system, which would then give patient-specific recommendations for antibiotic coverage. The ASCO Post, April 10, 2016. Bouaud J, Spano JP, Lefranc JP, . A clinical decision support system is one of the key components for reaching compliance for Meaningful Use. Bonnabry P, Despont-Gros C, Grauser D, . Kohn LT, Corrigan JM, Donaldson MS (eds). The authors wish to acknowledge the guidance of Terry Field and Diana Buist, members of the Health Care Systems (HCS) Cancer Research Network (CRN) and CRN Scholar Program Mentors, who contributed to the development of this project. Opportunities for a better use of healthcare resources. While electronic health records and databases help physicians manage this rising tide of information, patient-specific recommendations provided by clinical decision support systems can do even more by improving decision making and helping ensure patient safety. J Am Med Inform Assoc 1997;4:S20-S30. 2004 , Dr J. CDDS interventions found a significant impact on multiple outcomes relevant to antibiotic stewardship. 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. performed a comprehensive search of the literature to identify studies meeting the inclusion criteria. Available at: https://clinicaltrials.gov/ct2/home. , CDSS may have even more potential in applications that deliver unsolicited advice. J Oncol Pract 2017;13:e337â345. 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. CDS is typically built into the existing order entry system and provides information to healthcare providers about scan … Clinicians are also best placed to decide how CDSS should be implemented in local care environments. 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