Do Clinical Decision Support Systems Lead to Quality Improvement? (Part 2)

Clinical Decision Support Systems (CDSS) are a part of the spectrum of the capabilities of health information systems which have a transformational effect on the way medicine is practiced. They are defined by Musen et al., as any computer program designed to help healthcare professionals to make clinical decisions.  These tools are generally divided into:

1. Tools that focus attention e.g. focus on information that might be overlooked by the physician. An example is “case 1” in my previous post
2. Tools for information management: these tools help to retrieve information like textbooks and stored personal notes in a timely manner
3. Tools for providing patient specific recommendations: these provide advice based on data that is specific to individual patients.

These systems can be used for preventive care, diagnosis, planning or implementing treatment, follow-up management, hospital provider efficiency, cost reductions and improved patient convenience according to Berner et al.

These different uses of clinical support systems are not so clearly delineated but there are many areas of overlap. However, according to Musen et al., they can also be divided into tools that help with patient diagnosis and tools that help with patient management. These two are important distinctions and the authors discussed that there are two modes of interaction with these systems viz.: the consulting model in which the program advises the physician about patient care and the critiquing model, where the system evaluates the physician’s proposed line of management and corrects the choices he makes.

Despite the various classifications, it is clear that the systems cannot stand alone like the gadget in the movie, Star Trek which could be pointed at a sick person and make a diagnosis on the spot. Rather, it works hand in hand with the physician to make more effective choices that are beneficial to the patient. Some people think however, that there might be an effect on the clinical ability of the physician in the long run. I will resist the temptation to discuss this now, but will address this in subsequent posts. I will however like to know your thoughts on the matter as I have posted in the discussion session below. The utility of these systems and potential side effects will be discussed in my next posting. Stay tuned.

Below, is a video by Tom Garithe, the Editor-in-Chief of the American Journal of Obstetrics and Gynecology describing the difference between Electronic Medical Records and CDSS:

For discussion: 

Do you think clinical support systems will reduce the clinical acumen of physicians in the long run?