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Computerized Clinical Decision Support System

Clinical guidelines often include components for clinicians and for patients, yet, integrating evidence-based guidelines into clinical practice has proved to be a challenge.1,2

Computerized clinical decision support systems (CDSS) are tempting technological solutions to solve this knowledge transfer conundrum.

CDSSs that have been developed for a variety of clinical conditions have not, however, proven to be universally effective. Some barriers to effectiveness are failure of practitioners to use the CDSS, poor usability or integration into practice workflow, and non-acceptance by practitioners of computerized recommendations.3-5

Success has been more common in systems that:2,6

  • automatically prompt users rather than waiting for them to use the tool
  • have been developed by trial authors rather than externally
  • provide recommendations and not only assessments
  • provide decision support at time and location of decision-making

 

The MPA group has incorporated many of these features into the development of their CDSS to guide clinicians in diagnosis of the pain, make treatment decisions, change treatment strategies, make referrals, educate patients and providers, set and monitor self-management goals, monitor disease and monitor responses to treatment.

(1) Kastner M, Estey E, Bhattacharyya O. Better guidelines for better care: enhancing the implementability of clinical practice guidelines. Expert Review of Pharmacoeconomics and Outcomes Research 11[3], 315-324. 2011.

(2) Waddell C. So much research evidence, so little dissemination and uptake: mixing the useful with the pleasing. Evidence Based Mental Health 2001; 4(1):3-5.

(3) Garg AX, Adhikari NKJ, McDonald H, Rosas-Arellano MP, Devereaux PJ, Beyene J et al. Effects of Computerized Clinical Decision Support Systems on Practitioner Performance and Patient Outcomes. JAMA: The Journal of the American Medical Association 2005; 293(10):1223-1238.

(4) Roshanov P, You J, Dhaliwal J, Koff D, Mackay J, Weise-Kelly L et al. Can computerized clinical decision support systems improve practitioners' diagnostic test ordering behavior? A decision-maker-researcher partnership systematic review. Implementation Science 2011; 6(1):88.

(5) Kensaku K, Caitlin AH, Balas EA, David FL. Improving clinical practice using clinical decision support systems: a systematic review of trials to identify features critical to success. BMJ 2005.

(6) MacDonald N, Flegel K, Hebert P, Stanbrook M. Better management of chronic pain for all. CMAJ 2011; DOI:10.1503/cmaj.111065