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Dissemination of CPRs: focus on Clinical Decision Support Systems (CDSS)

Dissemination of CPRs: focus on Clinical Decision Support Systems (CDSS)

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Dissemination of CPRs: focus on Clinical Decision Support Systems (CDSS)

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  1. Dissemination of CPRs: focus on Clinical Decision Support Systems (CDSS) Dr Emma Wallace

  2. Dissemination of Clinical prediction rules (CPRs) • Publicly accessible register of CPRs • Clinical decision support systems

  3. Overview of presentation • Introduction • Urinary tract infection (UTI) CDSS • Implementation

  4. 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. (2nd Ed.)

  5. Research evidence

  6. 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

  7. Benefits • Prescribing • Improves prescribing practices • Reduces medication errors • Preventatative health • Vaccination reminders • Screening • Diagnosis- to date more limited role

  8. 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

  9. 100% Test / treatment threshold Probability of disease Test / no treatment threshold 0% Thresholds in diagnosis

  10. CDSS: UTI, Diagnosis

  11. CDSS: UTI, Risk stratification

  12. CDSS: UTI, Management

  13. CDSS: UTI, Prescribing

  14. Implementation • Success rates of CDSS increased by; • Automatic provision of decision support as part of clinical workflow • Provision of decision support at time and location of patient encounter • Provision of a recommendation, rather than an assessment

  15. Barriers to implementation • Poor integration into clinical workflow • Low level of uptake by clinicians • Cost and time required to develop CDSS • GP software companies • Inadequate infrastructure (e.g. IT) • Competing demands

  16. This week in Annals of Internal Medicine... • Computerised handheld CDSS for PE diagnosis • Improved diagnostic decision making • Used Bayesian reasoning • Topical area