Effects of computerized clinical decision support systems (CDSS) on patient

1
Effects of computerized clinical decision support
systems (CDSS) on patient

• Presented by
• Brent Brummert

2
Objectives

• To describe computerized clinical decision
  support systems on patient outcomes
• To show reasons for resistance to this technology
• To describe hardware used for CDSS
• To describe software used for CDSS
• To review the CDSS
• To describe the information system

3
Objectives (cont)

• To list advantages of trend
• To list disadvantages of trend
• To describe ethical and legal issues of trend
• To describe informatics competencies required for
  this trend
• To describe functions and responsibilities of
  informatics nurse working with trend
• To provide a summary of trend

4
Hardware

• PDAs
• Computers
• Mobile phones

5
PDAs

• Secure wireless connection to maintain privacy
• Ability to write on, type into or speak into for
  communication
• Portable and can fit in most pockets
• Continuous updated information via web
• Extremely accurate analytical engine

6
Description of Information System

• Electronic handheld device designed for
  portability i.e. PDA
• Utilizes different types of software to
  accommodate hardware of device
• Assists in diagnosing and providing alternative
  treatments
• Improves efficiency in diagnosing patients
• Allows input of various signs and symptoms for
  analysis
• Used to reduce medical errors to help ensure
  patient safety
• (Wright, et al., 2009)

7
Review of System

• Clinical information system
• Used by physicians, nurse practitioners and
  physician assistants
• Assists user in diagnosis, treatment and
  documentation
• Microcomputer utilizing a local area network to
  transmit information to main computers
• Health level 7 used as data standards for system
• Would recommend for use by others
• (Pestotnik, 2005)

8
CDSS Software

• PEPID
• Healthshare
• Skyscape
• Epocrates essentials

9
Pepid

• Antidote reference with dosing indications
• Poisonous plant identification pictures
• Identification of toxic emergencies
• (Anonymous, 2010)

10
Healthshare

• Enables sharing of data amongst multiple provider
  organizations
• Provides additional functionality such as
  e-prescribing
• (Anonymous, 2009)

11
Skyscape

• Pocket book of infectious disease therapy
• AHFS dosing companion
• Handbook of adverse drug reactions
• Interpretive lab data guide
• Medical calculator
• (Brian, 2005)

12
Epocrates Essentials

• Gives healthcare providers differential diagnoses
  based on signs and symptoms
• Updated daily with supporting subscription to
  software company
• Provides disease information linked to
  pharmacology and laboratory information
• Provides a drug to drug interaction program to
  avoid adverse reactions
• (Platt, 2009)

13
Usability of Epocrates Essentials

• Software provides step by step instructions for
  input continually
• Possible diagnoses and essential information
  provided in easy to read format
• Provides valuable information relative to
  pharmacists, practitioners and nurses

14
CDSS on Patient Outcomes

• Software designed to interpret and analyze
  patient data
• Assists clinicians in making safer clinical
  decisions
• Clinical research utilizing randomized and
  nonrandomized trials evaluating patient outcomes
  showed an increase in patient outcomes
• CDSS improved practitioner performance 64 of
  controlled trials
• (Adhikari, et al. 2005)
• (Hikmet, 2002)

15
Resistance

• People utilizing CDSS technology meet resistance
• Mergers and acquisitions may be barrier to
  technology
• Institutions may lack financial incentives to
  adopt system
• Pace of implementing information technology in
  healthcare lags behind other industries
• (Legnini, et al. 2000)

16
Advantages of CDSS

• Gives practitioner alternative diagnoses and
  treatment possibilities improving care
• Accuracy superior to any human reducing risk of
  user error
• Easily accessible to carry while working with
  patients
• Uploads patient data to main frame allowing easy
  data transfer
• Ease of use insures less lengthy training for use
  by practitioner
• (Wright, et al., 2009)

17
Disadvantages of trend

• Costly to businesses to provide to employees
• May take away face to face interaction between
  practitioner and patient
• Hackers may find a way to compromise wifi
  transfer allowing access to patient information
• Practitioners may become dependent on CDSS, thus
  reducing critical thinking skills required

18
Ethical and Legal Issues

• Assumed liability for breach of patient
  information if compromised by hacker
• Potential lawsuits by patients if CDSS recommends
  treatment that causes harm
• Some patients may believe unethical for computer
  to make treatment decisions
• Some practitioners may find the use of CDSS
  unethical and refuse use of device

19
Informatics competencies required

• Practitioners will need basic computer skills to
  operate a CDSS
• Brief training and orientation will be required
  for optimal use of CDSS

20
Functions and Responsibilities of Informatics
Nurse with CDSS

• Informatics nurses will be responsible for
  keeping up with trends and updates pertaining to
  CDSS
• Practitioners will be required to upload all
  patient data to main frame securely
• Informatics nurses will be responsible for
  training and updating for practitioners

21
Summary of CDSS

• Overall positive addition to any healthcare
  facility
• Cost analysis will ultimately decide who adopts
  this technology
• Patient care will improve as a result yielding a
  more efficient business
• Practitioners will benefit from additional
  suggestions when faced with difficult cases
• (Adhikari, et al. 2005)

22
Reference

• Adhikari, N.K., Beyene, J., Devereaux, P.J.,
  Garg, A.X., Haynes, R.B. (2005). Effects of
  computerized clinical decision support systems on
  practitioner performance and patient outcomes a
  systematic review. The Journal of the American
  Medical Association, 10. Retrieved from
  http//www.ncbi.nlm.nih.gov/pubmed/15755945

23
Reference

• Anonymous, . (2010). Itunes. Retrieved from
  http//itunes.apple.com/us/app/pepid/id306091993?m
  t8
• Anonymous, . (2009). Advanced software
  technologies for breakthrough applications.
  Retrieved from http//www.intersystems.com/press/p
  resskit/healthsharebkgnd.html
• Brian, O. (2005, August 7). Skyscape week-
  clinical constellation. Retrieved from
  http//www.medpda.net/archives/005926.html

24
Reference

• Hikmet, U. (Designer). (2002). Capabilities of
  computerized clinical decision support systems.
  Web. Retrieved from http//images.google.com/img
  res?imgurlhttp//www.thejcdp.com/uploads/cimages/
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25
Reference

• Legnini, M.W., Whitmore, H.H., Wong, H.J.
  (2000). The Diffusion of decision support systems
  in healthcare are we there yet?. Journal of
  Healthcare Management, 45. Retrieved from
  www.ncbi.nlm.nih.gov/pubmed/11067416?doptAbstract
  
• Petonik, S. (2005). Clinical Decision Support
  Systems. Pharmacotherapy, 25 (8). Retrieved from
  http//www.medscape.com/viewarticle/510623_3

26
Reference

• Platt, A. (2009). Put a PDA in your practice for
  easy
• access to current medical information.
  Journal of the American Academy of Physician
  Assistants, 22 (5). Retrieved from
  http//www.emorypa.org/Documents/Allan20Articles/
  Review_PDA0509_1783.pdf
• Wright A, Sittig DF, Ash JS, Sharma S, Pang JE,
  Middleton B (2009). Clinical decision support
  capabilities of commercially-available clinical
  information systems. J Am Med Inform Assoc.
  16(5). Retrieved from http//www.openclinical.org
  /dssevalstudies.html