Difference between revisions of "Predictors of Clinical Decision Support Success"

Revision as of 18:02, 24 October 2015

This is a review of the paper by Bates et al from 2003, Ten Commandments for Effective Clinical Decision Support: Making the Practice of Evidence-based Medicine a Reality. ^[1]

Introduction

This paper tries to collect the wisdom from years of attempting optimization with clinical decision support (CDS) at Brigham and Women's Hospital in Boston, MA. The clinicians appreciated a discrepancy between optimal patient care and actual practice. A variety of examples are mentioned that refer to suboptimal care that is provided. Some of the examples cited included: only 50% of eligible patients receiving beta blockers, 27% anti-epileptic drug monitoring was indicated and half of those were drawn at incorrect times, only 68% of vancomycin orders didn't follow the Centers for Disease Control (CDC) guidelines. These instances provide the impetus to make changes for improvement. As stated in the paper, "We believe that decision support delivered using information systems, ideally with the electronic medical record as the platform, will finally provide decision makers with tools making it possible to achieve large gains in performance, narrow gaps between knowledge and practice, and improve safety." The authors have refined their clinical decision support tools with both successes and failures.

The Ten Commandments

1. Speed Is Everything

2. Anticipate Needs and Deliver in Real Time.

3. Fit into the User's Workflow.

4. Little Things Can Make a Big Difference.

5. Recognize that Physicians Will Strongly Resist Stopping.

6. Changing Direction Is Easier than Stopping.

7. Simple Interventions Work Best.

8. Ask for Additional Information Only When You Really Need It.

9. Monitor Impact, Get Feedback, and Respond.

10. Manage and Maintain Your Knowledge-based Systems.

References

1. ↑ Bates DW, Kuperman GJ, Wang S, et al. Ten Commandments for Effective Clinical Decision Support: Making the Practice of Evidence-based Medicine a Reality. Journal of the American Medical Informatics Association : JAMIA. 2003;10(6):523-530. doi:10.1197/jamia.M1370. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC264429/

Submitted by Marc Tobias