CLINICAL DECISION SUPPORT TOOL/ CDSS

Patient Monitoring and Management

- In patient monitoring and management, CDSSs are valuable for monitoring
patients, tracking vital signs, progress, and issuing reminders for follow-up
appointments. Medtronic's CDSSs provide real-time patient data, analytics, and
alerts for immediate attention, enabling healthcare providers to deliver timely
and personalized care for chronic conditions.

HISTORY OR BACKGROUND
It was in 1625 that Santorio of Venice, assisted by his close friend Galileo,
published instructions on how to use a spirit thermometer to take a person's body
temperature and a pendulum to measure their heart rate. Their findings, meanwhile,
were mostly disregarded. The first documented scientific report on pulse rate did not
surface until Sir John Floyer published "Pulse-Watch" in 1707.

In 1852, Ludwig Taube published the first-ever plot of a patient's fever, which
included respiration rate among the trackable human vital signs at the time. The
standard vital signs that medical personnel watched at the time were body temperature,
heart rate, and breathing rate. These were solidified by subsequent advances to the
thermometer and clock.

The first "sphygmomanometer," or blood pressure cuff, was presented to

the medical community in 1896, adding arterial blood pressure as a fourth vital sign to
patient monitoring protocols. Willem Einthoven created the string galvanometer, which
measures the ECG, seven years later in 1903; this invention earned him the Nobel
Peace Prize in physiology in 1924.

DESCRIPTION
Vital signs are measurements of the body's most basic functions. The four main vital
signs routinely monitored by medical professionals and health care providers include
the following:

● Body temperature

● Pulse rate

● Respiration rate (rate of breathing)

Blood pressure (Blood pressure is not considered a vital sign, but is often measured
along with the vital signs.)

Vital signs are useful in detecting or monitoring medical problems. Vital signs can be
measured in a medical setting, at home, at the site of a medical emergency, or
elsewhere.

CLINICAL ACTIVITIES/FEATURES
● Diagnosis Assistance: CDSS can assist healthcare providers in diagnosing
diseases by analyzing patient symptoms, medical history, and test results to
suggest potential diagnoses or differential diagnoses.
● Treatment Recommendations: CDSS can provide recommendations for
appropriate treatment options based on evidence-based guidelines, patient
characteristics, comorbidities, and medication interactions.

● Medication Management: CDSS can help healthcare providers in prescribing

medications by checking for drug allergies, drug interactions, dosage
adjustments based on patient parameters (e.g., renal function), and
recommending appropriate alternatives when necessary.

ISSUES/ CONCERNS
● Increased Workload: Even though CDSS have the potential to enhance clinical
Decision-making and patient outcomes, their use and implementation can
occasionally result in an increase in the amount of work that healthcare
practitioners have to do, particularly in the early stages of adoption or if the
system is not well integrated into current workflows (Meunier et al., 2023)

● Fragmented Workflow: CDSS (Clinical Decision Support Systems) are

computer programs that help healthcare providers make decisions about patient
care. However, sometimes these systems can make things harder for providers to
do their job smoothly, especially if they are separate from the systems providers
normally use. For example, early CDSS were often designed as separate systems
 that providers had to go to outside of their usual work area to use. This
interruption in their workflow could slow them down and be frustrating.
Workflow disruptions can result in higher cognitive effort, longer task
completion times, and less time spent directly interacting with patients. (Sutton
et al., 2020).

● Impact on user skill: It was the exclusive responsibility of nurses, pharmacists,

and healthcare professionals to double-check orders prior to CPOE and CDSS.
It's vital to debunk the notion that CDSS implies order accuracy verification is
automatic or unnecessary.85 CDSS can leave this impression. It's crucial to take
into account a CDSS's possible long-term effects on consumers. A CDSS can
have a training effect over time, potentially eliminating the need for the CDSS
itself. The term "carry-over effect" refers to the tendency for CDSS to be
instructional in nature. On the other hand, providers may become overly
dependent or trusting of a CDSS for a certain task (Sutton et al., 2020).

● CDSS functionality could rely on individuals' proficiency with computers:

When using a CDSS, a lack of technological proficiency can be a barrier.
Depending on the specifics of the CDSS's design, this can vary, although some
have been found to be unduly complex and to rely too heavily on user talent
(Sutton et al., 2020).

● Financial Challenges: Setting up and getting new equipment ready to use can
be expensive. This is because you have to pay for the initial setup, which
includes teaching new employees how to use the equipment. Plus, you'll need to
keep spending money on updates to keep the equipment working well and
up-to-date with the latest information. So, ongoing costs are something to think
about (Sutton et al., 2020).

Group Members:
Blancaver, Ayheza
Cane, Bianca
Cena, Luigie
Lequin, Jacob
Santos, Alliah
Placencia, Mica

SOURCES:
● e2aglen. “Patient Monitoring Systems | a Brief History.” Glenmed, 21 Sept. 2017,

www.glenmedsolutions.com/2017/09/21/history-patient-monitoring-systems/.

● Meunier PY, Raynaud C, Guimaraes E, Gueyffier F, Letrilliart L. Barriers and Facilitators

to the Use of Clinical Decision Support Systems in Primary Care: A Mixed-Methods

Systematic Review. Ann Fam Med. 2023 Jan-Feb;21(1):57-69. Retrieved from

10.1370/afm.2908. PMID: 36690490; PMCID: PMC9870646.

● SPsoft. 2023, March 8. Examples of Clinical Decision Support Systems Application.

Retrieved from

https://www.linkedin.com/pulse/examples-clinical-decision-support-systems-application-

spsoft-com?fbclid=IwAR1Ifx30E-n5hK_0ZgQ5tOni14SkFt1f6mWnAlONemOS9HliA5

6wfzt4zN4_aem_AbGeZVDioYSVYU8VBLxdgBQw3g

● Sutton, R.T., Pincock, D., Baumgart, D.C. et al. An overview of clinical decision support

systems: benefits, risks, and strategies for success. npj Digit. Med. 3, 17 (2020).

Retrieved from https://doi.org/10.1038/s41746-020-0221-y.