1. Division of Population Health Sciences Royal College of Surgeons in Ireland Coláiste Ríoga na Máinleá in Éirinn Overview of utilization and examples of CDSSs and eCPRs Brenda Courtney, Borislav D. Dimitrov,Tom Fahey

2. Division of Population Health Sciences Overview of Presentation Section 1 International Register of Clinical Prediction Rules (CPRs) Section 2 Clinical Decision Support Systems (CDSSs)

3. Division of Population Health Sciences SECTION 1

4. Division of Population Health Sciences Electronic CPR Register International electronic register of CPRs Searchable electronic resource Web based user friendly access Manage and maintain register ( Bates et al. 2003 )

5. Division of Population Health Sciences Registry 1 2 3 4 5 6

6. Division of Population Health Sciences SECTION 2

7. Division of Population Health Sciences Clinical decision support system Clinical decision support system (CDSS) –Systems that are designed to improve clinical decision making Key points –Integrated with the electronic patient record –Available at the point of care –Computerised knowledge base –Provide patient-specific content

8. Division of Population Health Sciences Examples of CDSS CDSSDomainsInputOutput ATHENA Primary Care Hypertension EPRDrug Substitution, Addition, Dose Increase. DxPlain General MedicineClinical FindingsRanked list of possible diagnoses Isabel All major specialties Clinical FindingsList of up to 15 differential diagnoses GIDEONInfectious diseases Clinical FindingsRanked list of possible infectious diseases

9. Division of Population Health Sciences Implementation Clinical Domain : Pharyngitis CPR : Centor Score CDSS based on Bayesian reasoning –Reasoning engine  Software Algorithm Combining Clinical Prediction Rules in registry to patient data –Communication mechanism  Input : Electronic Patient Record Output : Diagnostic and therapeutic recommendations

10. Division of Population Health Sciences The Centor Score

11. Division of Population Health Sciences CDSS: CENTOR Score

12. Division of Population Health Sciences CDSS : Risk Stratification

13. Division of Population Health Sciences CDSS Management Recommendations

14. Division of Population Health Sciences CDSS Prescribing Recommendations Patient Specific

15. Division of Population Health Sciences Challenges to Implementation KnowledgeAttitudesBehaviour Sources of Behaviour Change Lack of familiarity 1.Time Investment 2.Inadequate infrastructure Lack of agreement 1.Uncertain application 2.Unclear applicability External Barriers 1.Lack of time 2.Resources 3.GP Software companies 4.Poor integration into workflow Barriers to Innovation Adapted from Lang et al. 2007

16. Division of Population Health Sciences Summary Section 1 Implement International Register for CPRs –Searchable across clinical domains –Public web based user friendly access –Maintained Section 2 Implement Clinical Decision Support Systems –Knowledge base –Software algorithms [Bayesian reasoning] –Integrated in electronic patient record