Dissemination of CPRs: focus on
Clinical Decision Support Systems
(CDSS)
Dr Emma Wallace
Dissemination of Clinical prediction
rules (CPRs)
 Publicly accessible register of CPRs
 Clinical decision support systems
Overview of presentation
• Introduction
• Urinary tract infection (UTI) CDSS
• Implementation
Introduction
‘ Computer systems designed to impact clinician
decision making about individual patients at the
point in time that these decisions are made’. 1
Key elements;
- Integration in electronic patient record
- Computerised format
- Patient specific information
1. Berner E. S. Clinical Decision Support Systems in Theory and Practice. Birmingham, AL. (2 nd Ed.)
4
Research evidence
Clinical decision support systems
• Clinician enters clinical data of patient
• Matched with system’s knowledge base
• Software generates patient specific
recommendations
• Provides evidence based decision support
for the clinician
Benefits
 Prescribing
- Improves prescribing practices
- Reduces medication errors
 Preventatative health
- Vaccination reminders
- Screening
 Diagnosis- to date more limited role
CDSS: Diagnosis
• Based on Bayesian reasoning
• Pre test probability of disease estimate
• Each new piece of clinical information increases or
decreases this probability (LRs)
• Post test probability
Thresholds in diagnosis
100%
Test / treatment threshold
Probability of disease
Test / no treatment threshold
0%
CDSS: UTI, Diagnosis
CDSS: UTI, Risk stratification
CDSS: UTI, Management
CDSS: UTI, Prescribing
Implementation
• Success rates of CDSS increased by;
1. Automatic provision of decision support as part of
clinical workflow
2. Provision of decision support at time and location
of patient encounter
3. Provision of a recommendation, rather than an
assessment
Barriers to implementation
1. Poor integration into clinical workflow
2. Low level of uptake by clinicians
3. Cost and time required to develop CDSS
4. GP software companies
5. Inadequate infrastructure (e.g. IT)
6. Competing demands
This week in Annals of Internal
Medicine...
• Computerised
handheld CDSS for PE
diagnosis
• Improved diagnostic
decision making
• Used Bayesian
reasoning
• Topical area