What is the status of Clinical and Hospital Administration DSS?
by Dan Power
Editor, DSSResources.COM
Both clinical and hospital administration decision support are evolving rapidly. HealthIT.gov is an excellent source of current status information. Clinical decision support (CDS) refers to computer-based tools that "provide clinicians, staff, patients or other individuals with knowledge and person-specific information, intelligently filtered or presented at appropriate times, to enhance health and health care. CDS encompasses a variety of tools to enhance decision-making in the clinical workflow. These tools include computerized alerts and reminders to care providers and patients; clinical guidelines; condition-specific order sets; focused patient data reports and summaries; documentation templates; diagnostic support, and contextually relevant reference information, among other tools." (http://www.healthit.gov/policy-researchers-implementers/clinical-decision-support-cds)
In 2006, I received an email from Mary Courty, a Decision Support
Manager in a Hospital setting, who was looking for individuals that
she could network with -- "do you know of any relevant DSS
professional organizations?" I told her about AIS SIG DSS and
indicated I'd check for relevant practitioner oriented Healthcare DSS
associations/meetings. My response email also asked her what type of
DSS she was working with? Clinical DSS or Hospital Administration
DSS? Mary responded I'm "on the administrative side and looking for
'best practice' reporting for financials."
At about the same time, I listened to a podcast titled "Healthcare
knowledge management in the 21st century". Perot Systems is
organizing podcasts related to Healthcare Tech and the World.
According to the press release, "Healthcare industry studies find
that medical literature doubles every 19 years and more than 2
million facts are needed to practice medicine." The podcasts are
exploring "the challenges of establishing methods to manage this
influx of new knowledge while transforming data into meaningful
decision support". Dr. Tonya Hongsermeier, Partners Healthcare System
(www.partners.org) Director of clinical knowledge management,
discussed why Partners has built knowledge management and decision
support systems. The 21 minute interview conducted by Dr. Kevin
Fickenscher is online at
http://perotsystems.mediaroom.com/index.php?s=pageF&item=19 .
Dr. Hongsermeier focuses on using expert systems to support
evidence-based medicine. Her team at Partners Healthcare in Boston
are aggregating and organizing an array of DSS to support many
diverse decision situations. They use a taxonomy to organize clinical
knowledge and various DSS. Hongsermeier emphasized that DSS uses and
needs differ for various targeted users, Doctors, Nurses,
Pharmacists, healthcare consumers. She asserted that research has
demonstrated that their decision support systems are improving
patient outcomes and reducing costs. She argues much needs to be done
to more widely deploy Clinical DSS. Vendors need to reduce task
interference, provide better functionality and improve pre-built
content. She also argued the insurers and government need to offer
incentives to speed adoption of Clinical DSS in Hospitals. Dr.
Hongsermeier is a great spokeperson for clinical DSS and Clinical
Knowledge Management. I encourage readers to listen to the podcast.
Healthcare professionals need more and better decision support
systems. Administrative decision makers need data-driven DSS for
performance monitoring, reporting and improved cost control. The
administrative side can also benefit from more model-driven DSS to
improve scheduling and utilization of facilities. Clinical decision
makers need more and better knowledge, model and document-driven DSS.
Communications-driven DSS can potentially assist in both
administrative and clinical decision making.
Healthcare Informatics is an expanding field of study, but it is not
my area of expertise. My background is in business administration so
Mary's DSS issues are more familiar to me. A Google search helped me
identify an expert in Health Informatics -- Prof. Enrico Coiera,
Faculty of Medicine, University of New South Wales. The second
edition of his book on the subject has 5 chapters on Decision Support
Systems topics. Coiera's book is "written for healthcare professionals
who wish to understand the principles and applications of information
and communication systems in healthcare. "
At www.coiera.com you can read Chapter 25 on Clinical decision
support systems (CDSS). Coiera notes "CDSS are by and large intended
to support healthcare workers in the normal course of their duties,
assisting with tasks that rely on the manipulation of data and
knowledge. An AI system could be running within an electronic patient
record system, for example, and alert a clinician when it detects a
contraindication to a planned treatment. It could also alert the
clinician when it detected patterns in clinical data that suggested
significant changes in a patient’s condition." Knowledge-driven
DSS are the most common Clinical DSS. Such systems can help in
diagnosis, therapy critiquing and planning, prescription of
medications, providing alerts, and image recognition and
interpretation. Coiera notes many CDSS are in clinical use. He states
"Many of these are small, but nevertheless make positive contributions
to care. Others, like prescribing decision support systems, are in
widespread use and for many clinicians form a routine part of their
everyday practice." One of the earliest Knowledge-driven clinical DSS
was PUFF, a tool to aid in interpretation of pulmonary function tests
(cf., Snow et al., 1988).
Coiera concludes that many benefits from CDSS have been reported in
the literature. He cites Johnson & Feldman, 1995, Evans, 1996 and
Sinchenko et al., 2002. The benefits are in three categories:
"1. Improved patient safety, e.g. through reduced medication errors
and adverse events and improved medication and test ordering;"
"2. Improved quality of care, e.g. by increasing clinicians’
available time for direct patient care, increased application of
clinical pathways and guidelines, facilitating the use of up-to-date
clinical evidence, improved clinical documentation and patient
satisfaction; and"
"3. Improved efficiency in health care delivery, e.g. by reducing
costs through faster order processing, reductions in test
duplication, decreased adverse events, and changed patterns of drug
prescribing favouring cheaper but equally effective generic brands."
Prof. Coiera also notes evaluation of CDSS is complex and a need
still exists for more systematic empirical studies. Prof. Coiera ends
his chapter with 3 provocative discussion points: 1. Which clinical
tasks are worth automating?; 2. Who is responsible if a CDSS makes a
recommendation to a clinician that results in patient harm?; 3.
Should clinicians be able to use a CDSS without any specific
training, or should we consider a CDSS as a specialised piece of
clinical equipment that requires the user to first pass a
certification course? Send me your responses to these questions and
please help me identify relevant practitioner-oriented Healthcare DSS
associations/meetings. The topic of Healthcare DSS probably warrants a
follow-up column. Please help me and DSS News readers learn more about
this important application area for computerized decision support
systems.
The 28th Annual Meeting of the Society from Medical Decision Making
(http://www.smdm.org/) will be held October 14-18, 2006 at the Hyatt
Regency in Cambridge, MA. This forum will emphasize "patient-centered
decision support systems, theory based interventions to promote
behavior change, and decision aids to improve clinical practice and
quality of care". The Society for Medical Decision Making's mission
is "to improve health outcomes through the advancement of proactive
systematic approaches to clinical decision making and
policy-formation in health care by providing a scholarly forum that
connects and educates researchers, providers, policy-makers, and the
public." I won't be able to attend, but perhaps someone will send me
a report about the highlights of the meeting.
References
Coiera, E., Guide to Health Informatics (2nd Edition), 2003,
http://www.coiera.com/ .
Evans, R.W., A critical perspective on the tools to support clinical
decision making. Transf 1996;36:671–673.
Sinchenko, V., J. Westbrook, S. Tipper, M. Mathie, E. Coiera,
Electronic Decision Support Activities in different healthcare
settings in Australia. In Electronic Decision Support for
Australia’s Health Sector, National Electronic Decision Support
Taskforce, Commonwealth of Australia, (2002) (available at
http://www.health.gov.au/healthonline/nedst.htm)v
Snow, M.G., R. J. Fallat, W. R. Tyler, S. P. Hsu,. Pulmonary consult:
concept to application of an expert system, Journal of Clinical
Engineering, 13(3), 201- 205, (1988).
08/17/2006 Perot Systems Podcast: 'Healthcare knowledge management in
the 21st century'
Please cite as:
Power, D., "What is the status of Clinical and Hospital Administration DSS?" DSS News, Vol. 7, No. 19, September 10, 2006.
Last update: 2016-05-13 04:31
Author: Daniel Power
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