Advances in Clinical Decision Support: Highlights of Practice and the Literature 2015-2016

Abstract

SummaryIntroduction: Advances in clinical decision support (CDS) continue to evolve to support the goals of clinicians, policymakers, patients and professional organizations to improve clinical practice, patient safety, and the quality of care. Objectives: Identify key thematic areas or foci in research and practice involving clinical decision support during the 2015-2016 time period. Methods: Thematic analysis consistent with a grounded theory approach was applied in a targeted review of journal publications, the proceedings of key scientific conferences as well as activities in standards development organizations in order to identify the key themes underlying work related to CDS. Results: Ten key thematic areas were identified, including: 1) an emphasis on knowledge representation, with a focus on clinical practice guidelines; 2) various aspects of precision medicine, including the use of sensor and genomic data as well as big data; 3) efforts in quality improvement; 4) innovative uses of computer-based provider order entry (CPOE) systems, including relevant data displays; 5) expansion of CDS in various clinical settings; 6) patient-directed CDS; 7) understanding the potential negative impact of CDS; 8) obtaining structured data to drive CDS interventions; 9) the use of diagnostic decision support; and 10) the development and use of standards for CDS. Conclusions: Active research and practice in 2015-2016 continue to underscore the importance and broad utility of CDS for effecting change and improving the quality and outcome of clinical care. KeywordsClinical decision support, quality improvement, medical order entry systems Yearb Med Inform 2017:125-32 http://dx

Advances in Sharing Multi-sourced Health Data on Decision Support Science 2016-2017

“…The breadth and overlaps of the activity in CDS did not allow us to exhaustively identify or describe every important or significant study or initiative. Throughout our review, we sought to identify the expansion or change across the thematic foci described in the previous IMIA review 5 , and to highlight policies and innovative efforts that cross boundaries of data sharing, technology, and application domains.…”

“…These literature and resources were evaluated for innovation and evidence of implementation beyond the 2016 IMIA Yearbook's 10 thematic areas of CDS 5 . Throughout, we looked for evidence of change or progress towards the next generation of anticipated interoperability models: (i) Sharing knowledge artifacts: developing computable standard knowledge artifacts that could be integrated and interpreted by others, (ii) Knowledge service providers with standards-based patient evaluation services: computable standard-based knowledge (e.g., clinical care guidelines), written once and incorporated anywhere, and (iii) Sharing standard applications: applications are developed and shared based on standard EHR Application Programming Interfaces (API) 6 .…”

A thematic analysis to examine the feasibility of EHR-based clinical decision support for implementing Choosing Wisely® guidelines

“…While such guidelines may be read and interpreted by clinicians on a case-by-case basis, a more effective and standardized approach for ensuring that CPGs are used in practice and followed as intended is to use clinical decision support (CDS) as the mechanism of delivery. 2 The use of CDS to facilitate CPGs in health systems has many practical benefits, such as overcoming issues with inaccessibility of knowledge at the point-of-care. 3 In addition, the use of CDS improves clinician adherence to a prescribed workflow (in this case, the directions of the guideline) 4 , 5 which often shows an improvement in patient outcomes.…”

Evaluation of ML-Based Clinical Decision Support Tool to Replace an Existing Tool in an Academic Health System: Lessons Learned

“…CDS tools have shown to improve provider and clinician performance [ 6 , 7 , 8 , 9 ]. The tools range in purpose from guiding medical diagnosis to informing therapeutic decisions.…”