Computerized Clinical Decision Support: Will it Transform Healthcare?

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Editorial Computerized Clinical Decision Support: Will it Transform Healthcare? Basit Chavdhry, MD, PhD J Gen Intern Med 23 Suppl. 1 85-7 DOI 10. 1007 /s11606-07-0432-9

Society of General Internal Medicine 2007

This editorial discusses the evolving problems of the American healthcare system and possible new paradigms for care delivery. It is not about perfecting current processes but creating entirely new methods of care. What role does health information technology play in improving care? With the core challenge of bringing evidence based medicine to the point of care, this editorial talks about two research articles published in this edition of Journal of General Internal Medicine. The first discussion involves the Agostino article which addresses the use of a qualitative evaluation of physician perception of of CDS related to sedative-hypnotics in older hospitalized patients. The goal was to reduce usage of diphenylamine or diazepam in patients > 65 years of age . The results were disappointing in that they only witnessed a drop of 3% in the usage of these drugs. The overall conclusion was that CDS needs to be embedded / tightly integrated into HIT. The second discussion is regarding the Garber & Matthew article. This paper examined the use of ISABEL, a CDS tool, to aid in determining potential diagnoses based on clinical narrative or manual entry of 3-6 key findings. Although the authors did reveal the underlying technology or search methods used, 48 of 50 New England Journal of Medicine case reports indicate ISABEL displayed the correct diagnosis in the top 30 diagnoses, or a rate of 3%. Although the performance of ISABEL was suboptimal and the study had methodological problems, there is some hope the textual data can be extracted from clinical narrative to produced a clinical differential diagnosis. They summarize that CDS is in an early developmental stage and the tools are not-precise, but development must continue. As a whole, CDS needs to understand how to influence physicians and decrease the burden of overwhelming amounts of evidence-based medicine; and for patients EBM should be applied. Reviewers comments: CDS is an important part of the improvement in patient care provided by health information technology. Although these two studies are somewhat disappointing we must continue to develop/evolve ways to Inform and educate physicians and Providers at the point of order entry or at clinical decision points. This area is ripe for new discoveries with thinking outside the box. Methods which can use already collected data from nursing documentation or physician documentation or order the entry process will maximize the value of CDS. Timothy H Hartzog, MD FAAP Medical Director of Information Technology Medical University of South Carolina