Development of a Clinical Decision Support System (original) (raw)

Development of a Clinical Decision Support System Introduction CDSSs aim for improving clinical decision-making and patient safety [88]. They can improve patient care by "providing the right information to the right person at the right point in workflow in the right intervention format through the right channel" [126]. CDSSs may support decisions passively, e.g., by error recognitions using computerized physician order entry (CPOE) and monitoring a patient situation, or actively, e.g., by providing alerts in unusual or dangerous situations, recommending medications, and supporting physicians to find optimal decisions. Active decision support systems that require a rethinking and reorganizing of decisions and health care plans from clinicians (e.g., support for diagnostic and treatment decisions) are more likely to fail their acceptance [154]. In such cases, clinicians ignore or overwrite the decisions of a system and, finally, stop using it. Once a CDSS is built, its clinical acceptance depends on an appropriate integration, by means of both its technical adaption to existing clinical systems, specifically to the local electronic health record (EHR), as well as user-friendly interfaces. Well developed and clinically integrated, CDSSs can minimize errors, promote patient safety, save time and, finally, decrease the costs of care [88]. A successful CDSS development and clinical integration requires to reach one of these expected benefits without impairing the remaining, or at least to increase the cost-benefit ratio [88] The work of Berner et al. [12] reviews CDSSs to investigate their impact and effectiveness on clinical decision-making and points out various challenges. Challenges concern technical issues, such as data integration, system development, issues around the vocabulary, system output and maintenance, as well as organizational and personal issues, such as vendors, developers and users, and, finally, legal and ethical issues. To address all these