Effects of computerized clinical decision support systems (CDSS) on patient

1. Effects of computerized clinical decision support systems (CDSS) on patient Presented by Brent Brummert

2. Objectives • To describe computerized clinical decision support systems on patient outcomes • To show reasons for resistance to this technology • To describe hardware used for CDSS • To describe software used for CDSS • To review the CDSS • To describe the information system

3. Objectives (cont) • To list advantages of trend • To list disadvantages of trend • To describe ethical and legal issues of trend • To describe informatics competencies required for this trend • To describe functions and responsibilities of informatics nurse working with trend • To provide a summary of trend

4. Hardware • PDA’s • Computers • Mobile phones

5. PDA’s • Secure wireless connection to maintain privacy • Ability to write on, type into or speak into for communication • Portable and can fit in most pockets • Continuous updated information via web • Extremely accurate analytical engine

6. Description of Information System • Electronic handheld device designed for portability i.e. PDA • Utilizes different types of software to accommodate hardware of device • Assists in diagnosing and providing alternative treatments • Improves efficiency in diagnosing patients • Allows input of various signs and symptoms for analysis • Used to reduce medical errors to help ensure patient safety (Wright, et al., 2009)

7. Review of System • Clinical information system • Used by physicians, nurse practitioners and physician assistants • Assists user in diagnosis, treatment and documentation • Microcomputer utilizing a local area network to transmit information to main computers • Health level 7 used as data standards for system • Would recommend for use by others (Pestotnik, 2005)

8. CDSS Software • PEPID • Healthshare • Skyscape • Epocrates essentials

9. Pepid • Antidote reference with dosing indications • Poisonous plant identification pictures • Identification of toxic emergencies (Anonymous, 2010)

10. Healthshare • Enables sharing of data amongst multiple provider organizations • Provides additional functionality such as e-prescribing (Anonymous, 2009)

11. Skyscape • Pocket book of infectious disease therapy • AHFS dosing companion • Handbook of adverse drug reactions • Interpretive lab data guide • Medical calculator (Brian, 2005)

12. Epocrates Essentials • Gives healthcare providers differential diagnoses based on signs and symptoms • Updated daily with supporting subscription to software company • Provides disease information linked to pharmacology and laboratory information • Provides a drug to drug interaction program to avoid adverse reactions (Platt, 2009)

13. Usability of Epocrates Essentials • Software provides step by step instructions for input continually • Possible diagnoses and essential information provided in easy to read format • Provides valuable information relative to pharmacists, practitioners and nurses

14. CDSS on Patient Outcomes • Software designed to interpret and analyze patient data • Assists clinicians in making safer clinical decisions • Clinical research utilizing randomized and nonrandomized trials evaluating patient outcomes showed an increase in patient outcomes • CDSS improved practitioner performance 64% of controlled trials (Adhikari, et al. 2005) (Hikmet, 2002)

15. Resistance • People utilizing CDSS technology meet resistance • Mergers and acquisitions may be barrier to technology • Institutions may lack financial incentives to adopt system • Pace of implementing information technology in healthcare lags behind other industries (Legnini, et al. 2000)

16. Advantages of CDSS • Gives practitioner alternative diagnoses and treatment possibilities improving care • Accuracy superior to any human reducing risk of user error • Easily accessible to carry while working with patients • Uploads patient data to main frame allowing easy data transfer • Ease of use insures less lengthy training for use by practitioner (Wright, et al., 2009)

17. Disadvantages of trend • Costly to businesses to provide to employees • May take away face to face interaction between practitioner and patient • Hackers may find a way to compromise wifi transfer allowing access to patient information • Practitioners may become dependent on CDSS, thus reducing critical thinking skills required

18. Ethical and Legal Issues • Assumed liability for breach of patient information if compromised by hacker • Potential lawsuits by patients if CDSS recommends treatment that causes harm • Some patients may believe unethical for computer to make treatment decisions • Some practitioners may find the use of CDSS unethical and refuse use of device

19. Informatics competencies required • Practitioners will need basic computer skills to operate a CDSS • Brief training and orientation will be required for optimal use of CDSS

20. Functions and Responsibilities of Informatics Nurse with CDSS • Informatics nurses will be responsible for keeping up with trends and updates pertaining to CDSS • Practitioners will be required to upload all patient data to main frame securely • Informatics nurses will be responsible for training and updating for practitioners

21. Summary of CDSS • Overall positive addition to any healthcare facility • Cost analysis will ultimately decide who adopts this technology • Patient care will improve as a result yielding a more efficient business • Practitioners will benefit from additional suggestions when faced with difficult cases (Adhikari, et al. 2005)

22. Reference: • Adhikari, N.K., Beyene, J., Devereaux, P.J., Garg, A.X., & Haynes, R.B. (2005). Effects of computerized clinical decision support systems on practitioner performance and patient outcomes: a systematic review. The Journal of the American Medical Association, 10. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/15755945

23. Reference: • Anonymous, . (2010). Itunes. Retrieved from http://itunes.apple.com/us/app/pepid/id306091993?mt=8 • Anonymous, . (2009). Advanced software technologies for breakthrough applications. Retrieved from http://www.intersystems.com/press/presskit/healthsharebkgnd.html • Brian, O. (2005, August 7). Skyscape week- clinical constellation. Retrieved from http://www.medpda.net/archives/005926.html

24. Reference: • Hikmet, U. (Designer). (2002). Capabilities of computerized clinical decision support systems. [Web]. Retrieved from http://images.google.com/imgres?imgurl=http://www.thejcdp.com/uploads/cimages/article_1119.jpg&imgrefurl=http://www.thejcdp.com/journal/view/capabilities-of-computerized-clinical-decision-support-systems--the-implica&usg=__7OyqMmj5rGjNwdijIwNu4VusoHE=&h=265&w=350&sz=20&hl=en&start=2&sig2=MKZ0KDeRkSYrf5WGTvwDDg&um=1&itbs=1&tbnid=YyftQrWv4rfYfM:&tbnh=91&tbnw=120&prev=/images%3Fq%3Dcomputerized%2Bclinical%2Bdecision%2Bsupport%2Bsystems%26hl%3Den%26rls%3Dcom.microsoft:en-us:IE-SearchBox%26rlz%3D1I7TSHB_en%26sa%3DN%26um%3D1&ei=PilsS8ncJNealAeVkoStBQ

25. Reference: • Legnini, M.W., Whitmore, H.H., & Wong, H.J. (2000). The Diffusion of decision support systems in healthcare: are we there yet?. Journal of Healthcare Management, 45. Retrieved from www.ncbi.nlm.nih.gov/pubmed/11067416?dopt=Abstract • Petonik, S. (2005). Clinical Decision Support Systems. Pharmacotherapy, 25 (8). Retrieved from http://www.medscape.com/viewarticle/510623_3

26. Reference: • Platt, A. (2009). Put a PDA in your practice for easy access to current medical information. Journal of the American Academy of Physician Assistants, 22 (5). Retrieved from http://www.emorypa.org/Documents/Allan%20Articles/Review_PDA0509_1783.pdf • Wright A, Sittig DF, Ash JS, Sharma S, Pang JE, Middleton B (2009). Clinical decision support capabilities of commercially-available clinical information systems. J Am Med Inform Assoc. 16(5). Retrieved from http://www.openclinical.org/dssevalstudies.html