Clinical Decision Support System (CDSS) Lecture 6 Kanar Fadhil Hidayat MSc

CDSS A (computer) system intended to provide clinical decision support(CDS) to clinicians, caregivers, and healthcare consumers. It could be in the form of an alert, reminder, recommendation, or informational notification regarding a patient. Automated CDSS includes a knowledge base(which contains stored facts and algorithmic logic method), an event monitor(data from a laboratory), and a communication system to the end user.

Computerized Provider Order Entry (CPOE) Automated portion of a clinical information system(e.g. PIS) that enables patient’s care provider to enter an order for a medication, clinical laboratory, radiology test, or procedure directly into the computer.

Types of Clinical Decision Support Systems Patient- Specific CDSS Commercial drug-interaction alerting systems. These are most common is CPOE and pharmacy information systems and provide alerts for drug- allergy, drug-drug, drug-pregnancy, and other kind of alerts.

The possible outcomes from this kind of alerting system True-Positive: produces an alert. Example: an allergy warning appears when penicillin is prescribed for a patient with a beta lactam allergy. Alert is relevant and clinician needs to see it. 2. False-Positive: produces an alert. Example: a duplicate drug warning for a patient appropriately prescribed two antibiotics. Clinician considers this alert an inconvenience and does not need to see it.

The possible outcomes from this kind of alerting system 3. True-Negative: produces no alert. Example: no alert fires when penicillin is ordered on a patient who has no beta lactam allergy. Clinician do not need to see an alert, there is no problem. 4. False-Negative is really a True-Positive, but produces no alert. Example: NO allergy warning for a patient with allergy, because the allergy is undocumented. The alert would be relevant and there is risk of harm.

Types of Clinical Decision Support Systems Non- Patient-Specific CDSS - These require a clinician to adapt general information to an individual patient and clinical situation.

Clinical Rules Clinical Rules is a real-time decision support module, which focuses on medication safety based on an in-depth risk profile of the patient.  Using clinical rules is a possible strategy to improve the CDSS. These rules generate alerts based on all patient characteristics available in the e- health record, e.g. laboratory values, dosage, the use of other drugs, etc.

Clinical Rules The aim of introducing clinical rules is improving patient safety by a better detection of risk situations and optimization of the relevance of alerts.

Clinical Rules

What is the Cognitive Process? Evaluate current therapy Add or discontinue medications Evaluate whether proper monitoring of medication is being done.

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