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Incorporating Evidence:
Use of Computer-Based
Clinical Decision
Support Systems
for
Health Professionals
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OBJECTIVES:
1. Define computerized clinical
decision support systems
(CDSS)
2. Identify types of CDSS, their
characteristics, and the levels of
responsibility implicit in the use
of each type
3. Describe effects of CDSS on
clinician performance and patient
outcomes in healthcare
4. Understand the features,
benefits and limits of CDSS
5. Develop a future vision for CDSS
within nursing.
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Decision Support System (DSS)
-are automated tools
designed to support
decision-making activities
and improve the decision-
making process and decision
outcomes
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Clinical Decision Support
System (CDSS)
-Designed to support healthcare
providers in making decisions
about the delivery and
management of patient care
-Goals may include: patient safety
& improved outcomes for specific
patient populations as well as
compliance with clinical
guidelines, standards of practice
and regulatory requirements
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Clinical Tasks of CDSS:
~Alerts and reminders
~Diagnostic assistance
~Therapy critiques and
plans
~Medication orders
~Image recognition and
interpretation
~Information retrieval
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Clinical Decision Support System
(CDSS)
EAny computer program
that helps health
professionals make clinical
decisions
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Clinical Decision Support System
(CDSS)
EAre software designed to be a
direct aid to clinical decision-
making, in which the
characteristics of an individual
patient are matched to a
computerized clinical knowledge
base and patient specific
assessment/recommendations
are then presented to the
clinician or the patient for a
decision
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Main Purpose of DSS are to:
Assist in problem solving with
semi structured problems

Support, not replace, the
judgment of a manager or
clinician

Improve the effectiveness of
the decision-making process
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Types & characteristics:
Administrative &
Organizational
Systems

Integrated Systems
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Included in the field of
healthcare decision support
are systems that:
Support organizational
Executive/managerial
Financial
Clinical decisions
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Administrative
System:
Designed for
finance/quality monitoring-
support the business
decision-making process
System encompass
decision processes other than
direct patient care delivery
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Administrative System:

Clinical in nature- such as
quality improvement systems
mainly used for strategic
planning, budgeting, financial
analysis, quality management,
continuous process improvement
and clinical benchmarking
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Integrated Systems
Able to support outcomes
performance management by
integrating
Operational data (the
business side) budgeting,
executive decision-making,
financial analysis, quality
management & strategic
planning data
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Integrated Systems
Clinical data (the clinical
side)- clinical event tracking,
results reporting,
pharmaceutical ordering &
dispensing, differential
diagnoses, real-time clinical
pathways, literature research
and clinical alerts
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Key CDSS Functions:
Administrative- support
for clinical coding and
documentation
Management of clinical
complexity and details-
keeping patients on
research and chemotherapy
protocols, tracking orders,
referrals, follow-up, and
preventive care
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Key CDSS Functions:
Cost control- monitoring
medication orders and
avoiding duplicate or
unnecessary tests

Decision support-
supporting clinical diagnostic
and treatment plan processes
promotion of best practices,
use of condition-specific
guidelines, and population-
based management
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Key CDSS Function Stan &
Sheps, 1998 according to :
Data-based systems
-Capitalize on the fundamental input into
any intelligent system
-They provide decision support with a
population perspective
Model-based DSS
Knowledge-based
systems
Graphics-based systems
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Model- based DSS
-Driven by access to and manipulation of a statistical,
financial, optimization and/or simulation model
-Data are compared to various decision-making and analytic
models

Knowledge-based systems (Evidence-Based Practice)
-rely on expert knowledge that is either embedded in the
system or accessible from another source and uses some
type of knowledge acquisition process to understand and
capture the cognitive process of healthcare providers

Graphics-based systems
-take advantage of the user interface to support decisions
by providing decision cues to the use in the form of color,
graphical representation options and data visualization
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Examples of CDSS Applications
1.Reminders and alerts which are
computer tools for focusing attention
such as flags for abnormal values
2.Therapy critiquing and planning as
well as care maps, guidelines,
protocols and so on
3.Diagnostic assistance providing
patient-specific consultations using
diagnostic or management tools,
such as Problem Knowledge
Couplers
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Examples of CDSS Applications
4. Lab systems with interpretation of
measured values and automated
preparation of reports as well as
physician guidance as to which tests
to order
5. Prescribing decision support such as
drug advisory systems used for
advising on drug-drug interactions,
side effects, selecting most cost-
effective drug
6. Clinical workstations with online
literature, e-tools for calculation,
patient guidelines
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7. Image recognition and interpretation
with capabilities of mass screening -
e.g. mammography, assistance with
expensive and complex
investigations- e.g MRI
8. Signal interpretation such as
interpretive alarms for real-time
clinical signals in intensive care unit
(ICU), automated electrocardiogram
(ECG) interpretation, retinal scans
and voice recognition
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9. Natural language/speech
recognition which offers
interpretation of freely entered
clinical notes and archiving to
make electronically accessible
in the future
10. Evidence-based quality
improvement using up-to-date
and consistent tools
11. Multitask tools for assessment,
diagnosis and management
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Barriers to the Use of
CDSS Systems
ELack of noticeable benefits
EInsufficient cost benefits
EInadequate staff training
ELack of system support
ESystem cost
ELack of exposure to technology
EUsers reluctance to use
automated decision support

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Implications for Future Uses
of CDSS in Nursing
Increasing Inclusion of
Patients
-allow patients or their
representatives access their
own medical records
-allow patient access to the
knowledge base of the system
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Implications for Future Uses
of CDSS in Nursing
Dual Purpose
Documentation
-first: improving care for the
individual patient
-second: improving care for
future populations of patients via
aggregated information used for
clinical decision-making
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CDSS
-Can improve patient care
quality
-Reduce medication errors
-Minimize variances in
care
-Improve guideline
compliance
-Promote cost savings