Clinical Decision Support and Knowledge Management

System in Healthcare

Is this what I am talking about ?

Outline

• Definition of Decision Support Software (DSS)• Types of DSS• Variables affecting effectiveness of DSS• Evidence of effect of DSS on Clinical Performance• Evidence for effectiveness of DSS in educating

healthcare professionals• Knowledge Management System in Healthcare• Conclusion

Definition of DSS

• Clinical Decision Support Systems provide clinicians with patient specific assessments or recommendations to aid clinical decision making. (Kawamoto et al, 2005 BMJ 330: 765-772)

“The computer can provide a better cockpit for clinicians , which can help them avoid errors, be more thorough, ands stay closer to the findings of the evidence base” (Bates et al, 2003, JAMIA 10: 523-530)

Removing barriers

• Research shows that clinicians with an identified knowledge gap are frequently left unable to fulfil that information need, because they can not access the knowledge that they seek within the clinical workflow.

• Integrating clinical decision-support information into your EHR system can also help improve the clinical acceptability and adoption of your EHR, by providing immediate benefit to the clinicians. By meeting clinician’s information needs, this can provide the direct benefits of improving the quality of care delivered to patients.

FROM THE BMJ EVIDENCE CENTRE

What is Decision Support Software

Types of Decision Support Software

• No clear classification schema at present• Information resources:

• Passive vs Active: • Passive: information associated with computerised program but

requires decision by the clinician to look for it eg information database, tool tips

• Active: Information automatically shown to clinician eg pathology report with interpretation

• Contextualised vs Generic• Contextualised: information specifically tailored to patient factors• Generic: Information general and requires interpretation by user

Types of Decision support software• Multiple formats DSS:

• Reminders: eg reminder to order K before prescribing digoxin when order for Digoxin placed

• Alerts: a more contextualised reminder eg A pop-up that warns that K is low when digoxin ordered

• Auto-population of fields and default values eg Digoxin dose automatically calculated on basis of algorithm and Clinician has to over-ride value to change this

• Forcing functions: System refuses Digoxin order until recent safe K available

• Diagnostic and care pathway algorithms: interpretation of clinical information with suggestions for actions or diagnosis

FROM THE BMJ EVIDENCE CENTRE

Evidence for use of DSS

• Meta-analysis of DSS on physician performance and patient outcomes (Garg et al JAMA 2005;293:1223-1238)

• DSS improved physician performance in 62% of studies (N= 97)

• DSS improved patient outcomes in 13% of studies (N= 52)• Difference partly attributed to inadequate power of

many studies to detect patient outcomes.• Effectiveness of DSS related to automatic prompts

and clinically self-designed systems

Evidence for effectiveness of DSS• Many studies have shown failures to change practice with

implementation of DSS

Variables Affecting usefulness and uptake of DSS

1. Perceived benefits of the DSS: • affected by clinician perceptions of technology,

independence, expertise, relevance etc. Similar to those for acceptance of guidelines

2. Extent to which DSS enhances or interferes with clinical workflows

• Patient-clinician factors• Frequency of interruptions• Triviality or importance of interruptions• Extent of actions by clinician to recommence

workflow

Variables Affecting usefulness and uptake of DSS• User friendliness of

software• Reliability and

accessibility of Software and hardware

• Time for clinician to learn use of system

• Overall approach to implementation of change

Knowledge Management System in Healthcare

Procedures of Knowledge Management

• Knowledge may be accessed at three different times: before, during, or after the event.

• The most beneficial and obvious times would be before and during the moment it is needed. 

• The KM-process goes through several stages: analysis, segmentation, correlation, clustering of the data and information and forecasting.

…Procedures of KM (cont.)

• The aspects of the diagnosis and care are analyzed and modeled.  Relationships and interrelations between them are analyzed and classified in the KM systems.  As information is built up over time, patterns of similar characteristics come together.

• The KM process involves documenting knowledge of processes that require improvement, methods to achieve improvement, and ways to measure outcomes of the change.  

…Procedures of KM (cont.)

• These procedures will continually help ensure that the best quality of information is archived.  

•  KM resources enables us to see the ‘whole picture’ and recognize the care and/or forecast for the involved cases. 

Implementation of Research Findings: “Debunked Assumption”

Changes in Practice

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Question

Hypothesis

Study

Publications

Example of change of practice

Knowledge Management Example

Double click the PDF file icon to open

Severe Sepsis Alert KM in HER

Systemic inflammatory response syndrome(SIRS)

Conclusion

• Knowledge Management in Healthcare has obvious benefits that could really make the difference in people's lives.

• There are still many healthcare facilities that still need to fully utilize these systems.