ScreenHunter_04 Oct. 27 17.06

Another Negative Test of Clinical Decision Support Systems

Despite great hope that clinical decision support systems (CDSS) embedded in EHRs will lead to better outcomes, it has been difficult to demonstrate the effectiveness of CDSS on clinical outcomes. This week, an article in the Archives of Internal Medicine (Anne Holbrook, MD, PharmD, MSc, FRCPC, et al) tested an intervention which, “…included personally tailored electronic vascular risk monitoring and treatment advice shared between the physician and patient, risk calculation, and a clinical resource.” The study design randomized 1,102 patients in 49 community-based physician practices.

The results included better performance on process measures for managing vascular disease, and acceptance by physicians and patients. In fact, the authors state that the CDSS was, “highly regarded.”

Here is the conclusion as offered by the authors:

Clinicians are correct to remain skeptical about the cost-effectiveness of these systems and should continue to demand evidence that they improve patient outcomes. To date, the benefit of both innovations has been greatly overstated and is not supported by the type of health technology appraisal that is routinely applied in most other domains of health care.

They go on to state:

We found that, despite favorable ratings from patients in terms of continuity of care and self-efficacy in handling their personal vascular risks and important improvements in the complex processes required to reduce vascular risk, clinical variables were not consistently improved. Large investments in CDSSs may not be warranted until the CDSSs and their associated EMRs have matured to a higher quality.

So… how do we make CDSS more effective?

See these other blog posts on CDSS and related topics in AmericanEHR:

– Clinical Decision Support: Can It Really Help You Be a Better Clinician?

– Seeing Promise & Peril in Digital Records

– Do EHRs & CDS Improve Quality of Care?

This post is the personal opinion of the author and does not necessarily reflect the official policy or position of the American College of Physicians (ACP). ACP does not endorse a specific EHR brand or product and ACP makes no representations, warranties, or assurances as to the accuracy or completeness of the information provided herein.



One response to "Another Negative Test of Clinical Decision Support Systems"
  • October 31, 2011
    Arvind Cavale

    I wish this report had been published before Meaningful Use Criteria were set. For experienced EHR users like me, this comes as no surprise. Clinical decision should be a clinician’s innate process, and should be developed as part of training & experience. Having a computer programmer somehow create this thought process via pre-fixed algorithms in an EHR is by definition an admission of clinical incompetence. This idea should be shelved, at least until all clinicians who use their brains and experience to care for their patients, are extinct. Making CDSS a formal part of an EHR is like placing competent clinicians on the “Endangered Species List”.

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