Clinical Decision Support Systems The revolution for a better health care

Clinical Decision Support Systems The revolution for a better health care

CDSS Definition Clinical Decision Support systems link health observations with health knowledge to influence health choices by clinicians for improved health care".

The 5 CDSS benefits according to the US Government (Government Helath IT) Approx. 10-12% of the health care budgets could be saved with professional CDSS 1 2 3 4 5 Reduce the risk of medication errors Reduce misdiagnosis Provide resistent and reliable information Improve efficiency and patient throuput Access all information in one place (EMR) Page 3

The CDSS Components All 6 components build the fully integrated Clinical Decision Support System 6. Inference Engine IF EMR 1. Electronic Medical Record. CCM CDSS TBD 5. Chart Compliance Monitor WFM KDB 2. Terminology Data Base 4. Work Flow Manager 3. Knowledge Data Base

The integrated CDSS Process (online) Start Data Entry Data Process Output Terminology Data Base Knowledge Data Base WFM Patient Chart Chart Compliance Monitor CDSS Inference Engine The EMR system is designed for the use of structured data (for meaningful use The WFM (Work Flow Management) guides the user through the predefined clinical pathways The patient chart data are filtered and analysed by the CDSS inference engine. The CDSS output is presented online in real time. The objects can be text, reference images and templates

CDSS sample process for retinal eye disease (1) The EMR is designed to store all patient data for meaningful use with structured codes and terms. The user interface is template based for easy and fast data entries.

CDSS sample process for retinal eye disease (2) Based on the reported chief complaint or symptoms the system offers a pre-defined process for the work up and the following clinical pathways (work flow manager). The work flows can be customized for all relevant clinical pathways.

CDSS sample process for retinal eye disease (3) The Chart Compliance Monitor reminds the physician or the clinical team if important and relevant information have not been entered. That ensures a compliant chart for the meaningful use of the clinical decision support system (CDSS).

CDSS sample process for retinal eye disease (4) The inference engine identifies cases which fulfill one or more CDSS profiles (patterns). The corresponding information from the knowledge data base (all kind of documents like publications, guidelines, reference images etc.) can be displayed for the support of the clinical decision process.

CDSS sample process for retinal eye disease (5) The physician can choose the preferred knowledge document (patient education, study results, reference images, clinical guidelines etc.)

Knowledge based Processes 5 S Pyramid of Evidence in Medicine

The CDSS Knowledge Sources Knowledge can be provided by external sources or can be generated by the user External 5 S Levels Original journal articles. Systemic reviews. Evidence based journal abstracts Evidence based guidelines Computerized decision support Study Criteria QM SOPs Internal Guidelines Admin Rules Marketing Information Patient Education Consent Forms Publications Official Guidelines Study Outcome Insurance Info Reference Images Regulatory Text Legal Info Drug Information Treatment Plans

CDSS based clinical process (step 1-6) Step 1 Patient Step 2 CDSS Step 3 CDSS Step 4 Provider Step 5 CDSS Step 6 Provider Reporting symptoms and reason for visit Proposing exam routine/clinical pathway Proposing the potential observation list Choosing and entering findings and test results Proposing corresponding differential diagnosis Choosing the relevant diagnosis

CDSS based clinical process (step 7-12) Step 7 CDSS Step 8 Provider Step 9 CDSS Step 10 CDSS Step 11 CDSS Step 12 Patient Providing up to date corresponding guidelines Deciding about evidence based treatment Providing individual patient education Storing the individual treatment plan Organizing the re-call (e-mail, text message etc.) Returns for follow up

CDSS is the Front Runner in Healthcare IT Example Healthcare IT M&A Investments 2012 Q2 USA (Source: Mercom Capital Group) Clinical Decision Support Systems Electronic Health Record Electronic Medical Record Asset Record Business Intelligence Coding Information Systems Medical Imaging Health Insurance Exchange