1. Dissemination of CPRs: focus on Clinical Decision Support Systems (CDSS)
Dr Emma Wallace

2. Dissemination of Clinical prediction rules (CPRs)
Publicly accessible register of CPRs
Clinical decision support systems
We envisage disseminating CPRs in 2 ways

3. Overview of presentation
Introduction
Urinary tract infection (UTI) CDSS
Implementation

4. Introduction
‘ Computer systems designed to impact clinician decision making about individual patients at the point in time that these decisions are made’. 1
Key elements;
Integration in electronic patient record
Computerised format
Patient specific information
1. Berner E. S. Clinical Decision Support Systems in Theory and Practice. Birmingham, AL. (2nd Ed.)

5. Research evidence
This triangle represents the various components of EBM and as you can see CDSS sits at the top of the triangle as a way in which EBM can be implemented.

6. Clinical decision support systems
Clinician enters clinical data of patient
Matched with system’s knowledge base
Software generates patient specific recommendations
Provides evidence based decision support for the clinician

7. Benefits Prescribing Improves prescribing practices
Reduces medication errors
Preventatative health
Vaccination reminders
Screening
Diagnosis- to date more limited role

8. CDSS: Diagnosis Based on Bayesian reasoning
Pre test probability of disease estimate
Each new piece of clinical information increases or decreases this probability (LRs)
Post test probability

9. Thresholds in diagnosis
Test / treatment threshold
Test / no treatment threshold
Probability of disease
100% 0%

10. CDSS: UTI, Diagnosis

11. CDSS: UTI, Risk stratification

12. CDSS: UTI, Management

13. CDSS: UTI, Prescribing

14. Implementation Success rates of CDSS increased by;
Automatic provision of decision support as part of clinical workflow
Provision of decision support at time and location of patient encounter
Provision of a recommendation, rather than an assessment

15. Barriers to implementation
Poor integration into clinical workflow
Low level of uptake by clinicians
Cost and time required to develop CDSS
GP software companies
Inadequate infrastructure (e.g. IT)
Competing demands

16. This week in Annals of Internal Medicine...
Computerised handheld CDSS for PE diagnosis
Improved diagnostic decision making
Used Bayesian reasoning
Topical area