This week we learned about the potential benefits and drawbacks to clinical decision support systems (CDSSs). Create a “Pros” versus “Cons” table with a column for “Pro” and a separate column for “Con”. Include at least
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This week we learned about the potential benefits and drawbacks to clinical decision support systems (CDSSs). Create a “Pros” versus “Cons” table with a column for “Pro” and a separate column for “Con”. Include at least 3 items for each column. Next to each item, provide a brief rationale as to why you included it on the respective list.
Clinical Decision Support Systems (CDSS) aid in screening patient data from various sources and then integrate that information into a single source.
Benefit and drawbacks to Clinical Decision Support Systems
Pros
Cons
Improved care. Doctors use CDSS to diagnose and improve patient care by eliminating unnecessary testing, improving patient safety, and avoiding costly complications.
Alert fatigue for clinicians. The alerts triggered by a CDSS can overwhelm caretakers who also receive prompts from other technology systems. In practice, 49% to 96% of alerts are overridden, raising questions about the effectiveness of decision support (Ancker et al., 2017).
Allows for faster decision-making. Increases the effectiveness of the decisions made due to its capacity to identify relevant data. The use of clinical decision support systems hence reduce the errors promoting patient safety and improving patient outcomes.
Shift of responsibility - easy to blame computer. The danger can be that the doctor gets used to just filling boxes and not relying entirely on his/her knowledge when it comes to providing treatment to a patient who has multiple health conditions. It is best to be sure that the doctor is the one who decides on diagnosis and treatments.
Has been seen to improve collaboration and communication within groups. Helps communicate with healthcare team immediately. Have the ability and tools to help physicians and nurses make better care decisions. For example, clinical decision support tools, like making medication recommendations based on diagnosis, and built-in clinical pathways, which help guide a hospital through
May reduce skill in staff, because they become dependent on the computers. If misused, it can be detrimental to the patient's health. Also, the danger can be that the doctor gets used to just filling boxes and not relying entirely on his/her knowledge when it comes to providing treatment to a patient who has multiple health conditions.
recommended procedures, and help ensure patients receive the best care.
2. The primary goal of a CDSS is to leverage data and the scientific evidence to help guide appropriate decision making. CDSSs directly assist the clinician in making decisions about specific patients. For this discussion thread post, you are to assume your future role as an APN and create a clinical patient and scenario to illustrate an exemplary depiction of how a CDSS might influence your decision. This post is an opportunity for you to be innovative, so have fun!
A CDS (Clinical Decision Support) usually provides clinicians, patients, staff or other people with person-specific information, and knowledge in enhancing health care. The system encompasses various tools that help in decision making in the clinical workflow. Some of the tools are computerized alerts as well as reminders for patients and providers. Programs are being developed to help the clinician make his or her job easier and faster. There are benefits regarding the CDSS in the hospital setting. Some of the benefits include increased care quality, improved health results, and avoidance of errors as well as adverse events. More so, there is enhanced efficiency, cost-benefit, and patient and provider satisfaction. The CDSS helps in reducing the risks associated with medication errors especially to children and infants during emergency situations. The system can do complex calculations fast and efficiently with minimal mistakes. There is a reduction of misdiagnosis, and the CDSS drastically improves the margin existing in the diagnostic error. The CDSS provides the medical team with reliable, and consistent information. As an APN, I would use the CDSS on a patient with Obstructed Sleep Apnea (OSA), who is experiencing frequent episodes of partial or complete upper airway obstruction during sleep. These frequent obstructions result in recurrent oxygen desaturations, hypercarbia, sleep fragmentation, and increased fluctuations in intrathoracic pressure. Over time, these effects contribute to substantial morbidity and mortality (Williams, 2017, p. 42). As the APN inputs that the patient has a history of OSA, a BPA comes up on the screen to order the OSA order set. This includes having a Respiratory Therapist to come talk with the patient to determine if CPAP use is needed, if supplemental oxygen should be set up, or if a sleeping trial should be ordered after discharge. The BPA notifies the APN that the patient has OSA, and it is flagged for discussion during any sedating procedure. According to Mei-Chen et al (2015), when patients use their CPAP long-term, they have increases in sleep quality and reduced cardiovascular comorbidities with lower blood pressure. Knowing this information can provide the nurse with more facts to present to the patient who has OSA, in order to help with compliance. Another example is that an EKG or Lab work can be performed and uploaded to a record in real-time and the doctor can plan treatment faster, which shortens delays and improves patient outcome. This helps to keep all the patient’s information in one location, and allows patient to be more pro-active in their care.
Mei-Chen, Y., Yi-Chih, H., Chou-Chin, L., Yao-Kuang, W., & Kuo-Feng, H. (2015). Beneficial effects of long-term cpap treatment on sleep quality and blood pressure in adherent subjects with obstructive sleep apnea. Respiratory Care, 60(12), 1810-1818. doi:10.4187/respcare.04199
Glaser, J. (2008). The Clinical decision support: The power behind the electronic health records. Healthcare Financial Management, 62(7), 46–48, 50–51.
Kesselheim, A. S., Creswell, K., Phansalkar, S., Bates, D. W., & Sheikh, A. (2011). Clinical decision support systems could be modified to reduce “alert fatigue” while still minimizing the risk of litigation. Health Affairs, 30(12), 2310–2317.
Ancker, J. S., Edwards, A., Nosal, S., Hauser, D., Mauer, E., & Kaushal, R. (2017). Effects of workload, work complexity, and repeated alerts on alert fatigue in a clinical decision support system. BMC medical informatics and decision making, 17(1), 36.
Hello Yehudis
I enjoyed reading your post on the pros and cons and the patient scenario using CDSS. A clinical decision support system is a tool that assists nurses and other health practitioners in decision making and keeps records and relevant information of patients. In this time and age, the use of technology in the delivery of healthcare has become a target for many healthcare institutions, because of the benefits that these technologies have on the quality of healthcare that patients receive. In the past, healthcare providers have been making clinical decisions based on their personal reasoning, but the innovation of the clinical decision support system (CDSS) has brought about changes in the process of making decisions by the nurses. The system provides assistance during care, integrates workflows, and recommends a care plan. There are benefits regarding the CDSS in the hospital setting. Some of the benefits include increased care quality, improved health results, and avoidance of errors, as well as adverse events. More so, there is enhanced efficiency, cost-benefit, and patient and provider satisfaction.
Diabetes is considered among the most dangerous chronic diseases and an economic burden due to the direct and indirect costs that are sustained during its management. The treatment of diabetes varies from one patient to another because there are different types of diabetes, including Type I diabetes, Type 2 diabetes, and Gestational diabetes. The management of each of these conditions varies with the type. There are several challenges that might be experienced while using clinical decision support system (CDSS) in the management of diabetes. The patient information stored in the system might be misinterpreted or misrepresented. In the medical field, it is important to develop new knowledge to help healthcare providers’ combat new symptoms and diseases. Lack of new and updated information in the systems might be a challenge in using the CDSS. The information is prone to potential security and privacy issues.
Digital systems are prone to security breaches and patient privacy is threatened by security breaches. As Nurse Practitioners, using the CDSS has been shown to increase general practitioner performance, prescription monitoring, patient centered care and
decrease cost of care and chronic health conditions. NP’s are able to formulate a better treatment plan for managing health conditions, and facilitating better preventative care services to patients.
Hello Julia
Great post, I enjoyed reading your pros and cons regarding using the CDSS. Clinical decision support systems (CDSS) are computer-based programs that analyze data within EHRs to provide prompts and reminders to assist health care providers in implementing evidence-based clinical guidelines at the point of care. These systems provide clinical knowledge needed about patient or disease specific information to help them make effective decisions that would enhance patient care and improve clinical outcomes. I like your scenario, and that is why this system is important, because it is able to alert the NP that clinical consideration should be given when giving calcium to patients with renal insufficiency. The NP could have given something that could have caused harm to the patient, in not realizing his kidney functions. The CDSS helps in reducing the risks associated with medication errors especially to children and infants during emergency situations. The system can do complex calculations fast and efficiently with minimal mistakes. There is a reduction of misdiagnosis where the CDSS drastically improves the margin existing in the diagnostic error. Also the CDSS provides the medical team with reliable, and consistent information. The decision support system provides reliable information in time, hence becoming of great benefit during medication or care. It becomes evident that CDSS has more pros than cons hence the need to automate the hospitals for quality delivery of services, and consequent utilization of time during medication. The health records and retrieval of patients’ information to provide medication also depend heavily on the CDSS.
Currently as an RN I do utilize many different informatics tools to help with patient care. Some examples of clinical decision support systems are medication dosing support, order facilitators, point – of – care alerts and reminders, relevant information display, expert systems and workflow support. The CDSS is an application which analyzes data to help health care provider in decision making and improving patient care. Clinical Decision Support Systems include a wide range of functionalities. Their ultimate purpose is to help ensure that things are not “missed” during a patient’s care experience. By incorporating evidence-based best practices, CDSS help increase the
quality of care. They also help to standardize care, which increases the efficiency.
Any system that can streamline the workflow and increase efficiency, safety, and quality of care is beneficial to health care providers. The systems we currently have may not be perfect, but they are a work in p
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