Royal College of Surgeons in Ireland Coláiste Ríoga na Máinleá in Éirinn

1. Royal College of Surgeons in IrelandColáiste Ríoga na Máinleá in Éirinn Computer-Based Clinical Decision Support Systems (CDSSs) Borislav D Dimitrov

2. 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

3. I) Implementation of Evidence

4. II) Health Informatics – THE FUTUREEvolution of Functionality • 1 Record keeping • Medical records • Patient scheduling • Appointments • 2 Coding & prescribing • Morbidity coding • Drug prescribing • Drug interaction • 3 Communication • Laboratory • Health professional & patient • 4 Clinical knowledge • Clinical DSSs • Decision aids • Comparative clinical data

5. III) DSSs: definition and aspects - 1 Decision Support Systems (DSSs) - a class of computer-based information systems including knowledge-based systems that support decision-makingactivities: - parts/blocks: database/KB, model, user interface - components: inputs, user knowledge/expertise, outputs decisions - classifications: scope, relationships to user, mode of assistance, evolution, orientation

6. III) DSSs: examples - 2 Decision Support System (DSS) for John Day Reservoir Information Builders' WebFOCUS reporting software (DSS)

7. 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 patient-specific 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

8. IV)(Computer-based)eCDSS: example - 2

9. IV) eCDSS: example - 3 (CPR-based)

10. 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)

11. Additional-1: Classifications of DSSs (taxonomy) • Relationships to User: passive, active, cooperative • Mode of Assistance [driven by]: communication, data, document, knowledge, model • Scope: enterprise-wide, desktop • Evolution [support to]: single-user/model-oriented  executive ISs, group DSSs, organizational DSSs • Orientation [frameworks]: text, database, spreadsheet, solver, rule, compound (hybrid)

12. Additional-2: Clinical DSSs • Scope: • Information systems are designed to improve clinicaldecision making • Key elements: • Integration with EPR • Computerized knowledge base • Software algorithm • Provide patient-specific information

13. Additional-3: Clinical DSSs classifications (taxonomy) • Context: setting, task, optimization, point-of-care, barriers to recommended action, external incentives • Knowledge & Data Source: clinical source, update mechanism, data source, coding, customization • Decision Support: reasoning method (e.g., CPR), recommendation explicitness, logistical complexity, clinical urgency, response, • Information Delivery: format, mode, action integration, interactivity, explanations, • Workflow: data input intermediary, user, DM target, output intermediary, degree of integration