Category:Reviews

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The article describes the potential added value of emerging second generation Clinical Decision Support Systems (CDSS). While first generation CDSS mainly offer reactive hazard alerts and guideline-based reminders, second generation systems offer the user the recommended "action items" to follow the alert/reminder he has just encountered i.e. providing information regarding recommended next step action, and actually helping on executing it, in an interactive, workflow friendly way.

The author emphasizes some of the innovations IT professionals are likely to experience through second generation CDSS, essentially the variety of information support models to match variety of user profiles and needs:

1. Variety of time-to-knowledge tools: From infobuttons, which are links to succinct, ready for use within seconds, answers which are linked right from the patient's data screens in the EHR and intended to the point-of-care, through links to quick guides, up to full-text links that targets physician's education in a much broader way, making it unsuitable for execution during a medical encounter.


2. Multilevel reference: Newer CDSS serves critical information first and then surround it with more general, supporting information, enabling utilization of different levels of information at a variety of different workflows.


3. Workflow support: Upper level information can lead directly to relevant actionable tools such as order sets.


4. Delivering patient information reference: The diagnosis, test and procedure codes used in the EHR can trigger a targeted search of the CDSS reference library, offering to print or mail patient information handouts directed specifically to the encounter scenario. Furthermore, patient adapted CDS tools embedded in patient disease management tools, would enable patients to be more involved in their health related decisions.


5. Multimodal reference: Combining different information presentation mediums i.e. text, animation, illustrations, images and video which can be especially useful in medical procedures support, imaging and visual dependant diagnosis descisions.


6. Two-factor clinical questions: Providing information which is based on a combination of clinical parameters presented by the patient, such as CHF and diabetes, pulmonary embolus and renal failure etc.


The author concludes that an educated decision with regards to the purchase of healthcare IT systems requires mapping of the organizational own clinical environment and determining, in detail, the organization quality targets. This will lead to prioritization of CDS needs. Only then, a CDSS market research should be performed, aiming at fitting the nature, quality and performance of the available CDSS candidates with the organizational needs.


Yossef Bahagon M.D.

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