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8 Cards in this Set

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  • Back
What is clinical Decision support?
Electronic Decision support consists of computer applications to assist clinicians in making decisions about patient care

"Access to knowledge stored electronically to aid patients, carers, service providers in making decisions about health care"
What kinds of clinical decision support is there?
Active vs passive support
- making specific suggestions - one off, or continuing?
- critiqueing recorded actions - screw-up detection
- Tweaking/filtering information display
- Intelligent image processing
- Reminders? Alerts?

Decision support or decision making?
- Do we expect humans to learn from devices?
What are the goals of support?
Incluence outcome
- good things more likely; bad things less likely

Outcomes...
- Fatal events are only the tip of the iceberg
> easiest to measure, and most dramatic, but...
- Not fatal events
> side effects
> suboptimal treatment
> inappropriate treatment
- Non harmful events
> inefficiency & confusion
> inappropriate resource consumption e.g. bed stay, repeated re-investigation
What kinds of DS technology are there?
Statistical
- "93.467% of the time, things that quak and have webbed feet are ducks"

Model-based
- It's definitely a duck because you told me its mother was a duck

Neural Networks
- 'Of all the things you've shown me so far, it looks most like the ones you said were ducks'
What are the three main compopents of Electronic Decision support?
Three main components
- Knowledge
> CPG
> Commercial databases
> Based on expert opinion
- Rules
> Translation from knowledge to action (e.g. If... then... steps)
- Software
> Applies it all integrated with patient and clinical data on a desktop
Describe E-DSS.
Varies in complexity
Usually embedded in other computer applications e.g. EMR, pharmacy ordering systems.

Two main areas
- e-implementation of CPGs
> guide clinician during consultation
> therapeutic and management recommendations
- support for electronic prescribing and test ordering
> alert and reminder systems
> critique ordering by clients
What are the benefits of e-DSS?
Medication errors
- e-DSS combined with e-prescribing reduces medication erros that can result in patient harm.
- automated alerts for possible Drug
> interactions
> dosage errors
> allergies
- pharmacy-baced systems to alert the prescribing physician have also been shown to be effective.

Quality of Care (prescribing choices)
- Antibiotic decision support in ICU
> choice based on susceptibility
> dosage and frequency and duration of therapy (incorporate best evidence and local knowledge of susceptibility patterns

Alerts
- faster medication review

Compliance with guidelines
- reduce use of inappropriate diagnostic tests

Clinical Audit and Outcome analysis
- use data to review clinical practice patterns
> medication and test ordering for patient groups
> audit and feedback (quality improvement)

Cost and time effects
What factors affect a clinicians decision to change their behaviour?
Relative Advantage
Compatibility
Complexity
Trialability
Observability