Thursday, January 22, 2009

Computerized Clinical Decision Support (CCDS) Myth versus Reality

Many people have misconceptions about CCDS. They are unclear about its usefulness, and even more so they do not understand how it is developed and implemented. My article in the Journal of Trauma explains in detail the dire need for CCDS. Below is the abstract. J Trauma 2008 Feb Computerized clinical decision support: a technology to implement and validate evidence based guidelines.
Sucher JF, Moore FA, Todd SR, Sailors RM, McKinley BA
Department of Surgery, The Methodist Hospital, Houston Texas, USA.
Faced with a documented crisis of patients not receiving appropriate care, there is a need to implement and refine evidence-based guidelines (EBGs) to ensure that patients receive the best care available. Although valuable in content, among their deficiencies, EBGs do not provide explicit methods to bring proven therapies to the bedside. Computerized information technology, now an integral part of the US healthcare system at all levels, presents clinicians with information from laboratory, imaging, physiologic monitoring systems, and many other sources. It is imperative that we clinicians use this information technology to improve medical care and efficacy of its delivery. If we do not do this, nonclinicians will use this technology to tell us how to practice medicine. Computerized clinical decision support (CCDS) offers a powerful method to use this information and implement a broad range of EBGs. CCDS is a technology that can be used to develop, implement, and refine computerized protocols for specific processes of care derived from EBGs, including complex care provided in intensive care units. We describe this technology as a desirable option for the trauma community to use information technology and maintain the trauma surgeon/intensivist's essential role in specifying and implementing best care for patients. We describe a process of logical protocol development based on standardized clinical decision making to enable EBGs. The resulting logical process is readily computerized, and, when properly implemented, provides a stable platform for systematic review and study of the process and interventions. CONCLUSION:: CCDS to implement and refine EBG derived computerized protocols offers a method to decrease variability, test interventions, and validate improved quality of care. PMID: 18301226 [PubMed - indexed for MEDLINE] Finally, 2 key cartoons created by Matt Sailors and published in this article help tell the story of the myth of CCDS developement versus the stark reality.

The article concludes with this statement:

“Decision support” suggests that one’s decision might benefit from consensus among others confronted with the same or similar possibility of doubtful consequence, and timely awareness of it, i.e., a real time jury of (your) peers. Safety of the hospitalized patient, protected against errors of judgment when a decision is required, is a current issue, and mandates are forthcoming from the Federal government that will require implementation of EBGs specifically to improve patient safety. CCDS to implement and refine EBG derived protocols that provide standardized decision making offers a method to decrease variability, test interventions, and validate improved quality of care.

A question that should be asked is, “How much and what kind of CCDS do we want?” Given the relentless ability of computer technology to advance and make itself useful, implementing EBGs using CCDS is just an inkling of possibilities, and challenges, to come. But rest assured: It’s still your decision.