Do Clinical Decision Support Systems Lead to Quality Improvement? (Part 1)

Scenario 1:
 Imagine a cancer patient with a cocktail of medication. The physician wants to prescribe another medication for a recently discovered symptom. Should she prescribe drug A or B? Will there be any interaction with the current medication? She can tell if it will interact with some of the drugs, but not all- she decides to prescribe it anyway. Immediately she places the order, the computer system gives a warning beep followed by  sign: "potential drug interaction!" the doctor is thankful- she would not have thought of that problem and the pharmacist might not even have detected it. Such is the role of clinical support systems. Consider a similar warning sign below:

Source:Journal of Medical Internet Research

Scenario 2:
A physician is seeing a rare form of a disease. He last saw a similar patient during his residency program three years ago. He decides to place the patient on a particular line of management, as was done with the previous patient. As soon as he does this, a gentle alert is shown stating that studies show that there is a better line of management available, so he should re-consider his disease management plan.
These two hypothetical scenarios highlight the importance of clinical decision support systems.


In our ongoing discussions about quality in healthcare and the role of information technology, I have decided to discuss clinical decision support systems. In general, any intervention or program that can support a physician in making a diagnosis is a clinical decision support tool. An example of this might be a clinical handbook in a physician's pocket, a pharmacopoeia or prescribing guidelines- these provide support to the physician making a diagnosis and help her make appropriate decisions about the care of the patient. You would however have noticed that these tools are only useful at the point of care. There is no point having these tools after the patient has been discharged. These tools are also only for support and should not try to supplant the clinical acumen of the physician or his "cultivated intuition".

Source: juneshlam.com

Information technology seeks to make the use of these tools more efficient and relevant. To do this, the technology  has to have the features I mentioned above and more. Clinical decision support systems were thus developed to have the functionality of all these tools and be more accessible, but more importantly, they usually ride on already established health information systems or electronic health records. Without this, they would be relegated to the background or better termed "clinical reference tools"

How are these systems used and what can they do? These will be discussed in part II of this series. In part III, I will discus potential "side effects" or unintended consequences of these tools. In Part IV, I will discuss their impact on quality and if there is any evidence in this regard.

I would be glad to read your comments.