CDSS IMPACT ON CLINICIANS AND CLINICAL DECISIONS

NEED FOR EVIDENCE BASED PRACTICE

There

is growing pressure for clinicians including nurses to use knowledge at the point of care that is based on research evidence.

IIOM

institute of medicine report (2000) identified human error as a major source of patient care major mortality.

MEDLINE- early study that access did have

significant effect on physician resolution of diagnostic and treatment problems Lindberg et al.,1993.

GORMAN,ASH, and WYKOFF - found that

availability of information at the time of a patient visit would definitely impact care.

CDSS Clinical Decision Support Systemuse to find and prevent error related to gasp between optimal and actual practice can result in improve quality of care. Application of CDSS suggest the ability to lessen the incidence of adverse of drug infections, and the inappropriate use of antibiotics. CDDS the most valuable and widely used function they also identified that successful use of CDSSs requires integration of the system with the users normal workflow.

BARRIERS TO THE USE OF CDSS SYSTEM

according to Sims et al.(2001) only about half of the treatment used for patient care in internal and family medicine are supported with evidence of efficacy and knowledge to support the decision-making process.
Barriers identified included lack of noticeable benefits insufficient cost benefits.

CDSS selection is essential to system acceptance It is also important to consider how a cdss will effect organizational, and personnel attitudes.

ELEMENTS NEEDED FOR INFORMATICS

INFRASTRUCTURE
1.standardized vocabularies to describe patient diagnoses interventions and outcome 2.computer based methods to examine linkages among patient problems and characteristics healthcare interventions patient outcomes and the intensity of care sources and to examine practice variations.

3.An integral clinical information system where data required for quality improvement are both collected and return to the provider during routine processes of patient care.

EVALUATION OF CDSS
There

is need to evaluate cdss with sound studies the effect of cdss on clinical outcomes currently remains uncertain without valid and generalizable findings.

Three

Key Areas to Assess in CDSS Development are: 1. Cost management 2. Quality management 3. Information management

SITTIG (1999) CITES THE FOLLOWING FIVE

ELEMENTS
1. integrated real time patient database 2. data drive mechanism. 3. knowledge engineer. 4 time driven mechanism. 5 long term clinical data repository.