Royal College of Surgeons in Ireland
Coláiste Ríoga na Máinleá in Éirinn
Computer-Based Clinical Decision Support Systems (CDSSs)
Borislav D Dimitrov
Division of Population Health Sciences
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Contents
1) Clinical & Research Evidence: Implementation in Practice
2) Levels of Functionality in Health Informatics
3) Decision Support Systems (DSSs)
4) Clinical DSSs (computer-based / eCDSSs)
5) CPRs  EHR/EPR  eCDSSs: Better Decision-Making
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I) Implementation of Evidence
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II) Health Informatics – THE FUTURE
Evolution of Functionality
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1 Record keeping
– Medical records
– Patient scheduling
– Appointments
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3 Communication
– Laboratory
– Health professional &
patient
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2 Coding & prescribing
– Morbidity coding
– Drug prescribing
– Drug interaction
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4 Clinical knowledge
– Clinical DSSs
– Decision aids
– Comparative clinical
data
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III) DSSs: definition and aspects - 1
Decision Support Systems (DSSs) - a class of computer-based
information systems including knowledge-based systems that
support decision-making activities:
- parts/blocks: database/KB, model, user interface
- components: inputs, user knowledge/expertise, outputs decisions
- classifications: scope, relationships to user, mode of assistance,
evolution, orientation
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III) DSSs: examples - 2
Decision Support System (DSS)
for John Day Reservoir
Information Builders' WebFOCUS
reporting software (DSS)
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IV) Clinical DSSs: definition and aspects - 1
Clinical Decision Support Systems (CDSSs) – a direct aid to clinical
decision-making in which the characteristics of an individual patient
are matched to a computerized clinical knowledge base, and patientspecific assessments or recommendations are then presented to the
clinician and/or the patient for a decision (Sim at al 2001):
- scope: designed ot improve clinical decision-making
- key elements: integration with HER/EPR, computerised-knowledge
base, algorithm, patient-specific info
- classifications: context, knowledge & data source, decision
support, information delivery, workflow
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IV) (Computer-based) eCDSS: example - 2
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IV) eCDSS: example - 3 (CPR-based)
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V) Computer-Based (e)CDSSs - summary
• Increasing Healthcare Quality & Efficiency & Effectiveness
• Helping Clinical Decision-Making Process & Outputs
 Translating Knowledge & Novel Evidence into Practice (WP3)
International Register of CPRs  eCPRs  Integrated eCDSSs
 Diagnostic Accuracy () & Medical Errors (): Patient Safety ()
EHR/RCTs  Repository of CPRs  eCDSSs (TRANSFoRm Project)
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Additional-1: Classifications of DSSs (taxonomy)
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Relationships to User: passive, active, cooperative
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Mode of Assistance [driven by]: communication, data, document,
knowledge, model
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Scope: enterprise-wide, desktop
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Evolution [support to]: single-user/model-oriented 
executive ISs, group DSSs, organizational DSSs
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Orientation [frameworks]: text, database, spreadsheet, solver, rule,
compound (hybrid)
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Additional-2: Clinical DSSs
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Scope:
– Information systems are designed to improve clinical decision making
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Key elements:
– Integration with EPR
– Computerized knowledge base
– Software algorithm
– Provide patient-specific information
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Additional-3: Clinical DSSs classifications (taxonomy)
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Context: setting, task, optimization, point-of-care, barriers to recommended
action, external incentives
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Knowledge & Data Source: clinical source, update
mechanism, data source, coding, customization
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Decision Support: reasoning method (e.g., CPR), recommendation explicitness,
logistical complexity, clinical urgency, response,
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Information Delivery: format, mode, action integration, interactivity,
explanations,
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Workflow: data input intermediary, user, DM target, output intermediary, degree
of integration
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