Decision Support

Bedside Clinical Systems provides meaningful clinical decision support designed for clinicians by clinicians, to benefit patients, guide clinical, and administrative decisions and inform quality review.

What is Clinical Decision Support?
Clinical Decision Support is a widely used term for a wide range of entities, or varying degrees of value to healthcare professionals and organizations.  Clinical Decision Support Systems are not all the same.  A critical view is needed to dissect the hype from the value.

Clinical Decision Support Systems (CDSS) provide clinicians, staff, patients with knowledge and person-specific information presented at appropriate times to enhance health care.  It includes a variety of tools to enhance decision making in the clinical workflow and operates as components of a comprehensive Electronic Health Record (EHR) system or a standalone application.

CDSS Figure2

Potential Benefits of CDSS are clinical, administrative, and financial. They can be described as follows: 

  1. Standardization to reduce unnecessary variation of treatments and processes.
  2. Enabling best practice through immediate and routine integration of evidence-based practices into care pathways by making what is best for their patient also the easiest.
  3. Real-time review by aggregation and transparent clinical oversight by clinician administrators and quality managers.
  4. Improved Efficiency through clinical focus, reduced information overload and medical error mitigation.
  5. Direct Financial Benefits realized as savings after implementation by clinical quality and efficiency.  Many healthcare information technologies do not or have not provided these benefits – underscoring the importance of the careful development and evaluation before implementation that is routine with the company products.
  6. Financial Incentive Programs to enhance IT capability are common and may entitle hospitals to local and nation IT programs such as the American Recovery and Re-Investment Act, Canada Health Infoway, and others.

Ten Commandments for Effective Clinical Decision Support (JAMIA, 2003):

  1. Speed is everything
  2. Anticipate Needs and Deliver in Real-time
  3. Fit into the User’s workflow
  4. Little things can make a big difference: usability matters
  5. Recognize that Physicians will strongly resist stopping
  6. Changing direction is easier than stopping
  7. Simple interventions work best
  8. Ask for additional information only when you really need it
  9. Monitor impact, get feedback, and respond
  10. Manage and Maintain Your Knowledge-based Systems

The Ideal CDSS
Empowers the overall Healthcare IT infrastructure by providing hospitals with “high clinical impact” software applications.

Traditional hospital systems, driven by administrative needs, have addressed only “low clinical impact” needs for admissions, laboratory, radiology, and pharmacy (Stage 1).  The addition of vital signs into the electronic health record (Stage 3) enables real-time sharing of entered vital signs ‘data’ and precedes the addition of evidence-based CDSS (Stage 4).

Electronic BedsidePEWS is an example of a computerized clinical decision support system operating at this level that has consequent clinical and economic advantages.  Greater integration and aggregation of BedsidePEWS beyond individual patients further increases its capability and potential benefit. The planned BCS modules for aggregation and reporting will advance hospitals using these products to the highest capability level (Stage 7).

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