clinical decision support by hari

MISYS – SOLUTIONS FOR HEALTHCARE

Clinical Decision Support

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Sr.Business Analyst

2

At the end of the session you will know……

Decision Support systems a) Why Clinical support ?

b) How is that provided ?

Why Decision Support ? a) Need - why clinicians need that ? b) when are they used ? c) How is that Built ? d) Advantages of using this system

What if a Decision Support is not available ?

Some Best Known Decision Support Systems.

Decision Support Systems

• Support

• System Support

• Decision Support

• Clinical Decision Support

experience, solutions, results 3

Definition(s)

• Clinical Decision Support Systems are "active knowledge systems which use two or more items of patient data to generate case-specific advice.

• Clinical Decision Support systems link

health observations with health knowledge

to influence health choices by clinicians for

improved health care

• (CDSS) are interactive computer programs, which are designed to assist physicians and other health professionals with decision

making tasks.


Objective of a CDSS

• To assist clinicians at the point of care.

• Clinicians would interact with a CDSS to help determine diagnosis, analysis, etc. of patient data.

• Previous theories of CDSS were to use the CDSS to literally make decisions for the clinician.

• The clinician would input the information and wait for the CDSS to output the “right” choice and the clinician would simply act on that output.


Complexity in Treating patients

• Common Symptoms

• Vitals Resembling Closely

• Previous Case History ( For the patient )

• Previous Experiences ( For the prescriber )

• Ethnicity ( Asian , African , Hispanic , ………………………………………….. )

• Gender


How treatment is done by your doctor ?


Interactions

a) Drug to Drug b) Drug to Food c) Food to Food … etc.,


Drug Indication Possible Effects SOURCE : Compiled from references in the bibliography. Coumadin Anticoagulant (blood

thinner) Vitamin K is a nutrient in the body that helps blood to clot. Vitamin K is present in foods such as green, leafy vegetables and fish. It will interfere with a blood thinner like coumadin.

Dilantin Anticonvulsant (anti-seizure)

Vitamin D and folic acid levels in the body are decreased by the taking of these types of drugs.

Norvasc Antihypertensive (for high blood pressure)

Consuming foods high in sodium (i.e., licorice, processed meats, canned foods) will decrease the effectiveness of the drug.

Aspirin Anti-inflammatory/pain reliever

Taking large amounts of these drugs will cause a loss of Vitamin C in the body.

Birth control pills Oral contraceptives Women who take these drugs often have low levels of folic acid and Vitamin B 6 in the blood.

Dyazide/Thiazide Diuretics (water-eliminating)

Taking diuretics often leads to a loss of potassium in the body.

Tetracycline Antibiotic Calcium may interact with the effectiveness of the antibiotic. Avoid dairy products for two to three hours before and after taking the medicine.

Lipitor/Zocor Statins (cholesterol-lowering drugs)

Antioxidants (Vitamin A, C, E, B, folic acid) may interact with the drug by reversing its effect.

Prednisone Corticosteroid The drug may increase appetite thus increasing nutrient intake.

Lasix Diuretic (water-eliminating)

The drug may decrease appetite thus decreasing nutrient intake.

Why is it so important to be aware of Interactions ?


What Essentially is one such CDSS ?


Key functions of CDSS

Four key functions of electronic clinical decision support systems

• "Administrative: Supporting clinical coding and documentation, authorization of procedures, and referrals.

• "Managing clinical complexity and details: Keeping patients on research and chemotherapy protocols; tracking orders, referrals follow-up, and preventive care.

• "Cost control: Monitoring medication orders; avoiding duplicate or unnecessary tests.

• "Decision support: Supporting clinical diagnosis and treatment plan processes; and promoting use of best practices, condition-specific guidelines, and population-based management. "


Types of CDSS

There are two main types of CDSS

• Knowledge-Based

• NonKnowledge- Based


Features of a Knowledge-Based CDSS

Most CDSS consist of three parts

• The knowledge base

• Interface engine,

• Mechanism to communicate.

The knowledge base contains the rules and associations of compiled

data which most often take the form of IF-THEN rules.

If this was a system for determining drug interactions, then a rule might

be that IF drug X is taken AND drug Y is taken THEN alert user.

Features of a non-Knowledge-Based CDSS

• CDSS that do not use a knowledge base use a form of artificial

intelligence called Machine learning, which allow computers to learn

from past experiences and/or find patterns in clinical data.

Two types of non-knowledge-based systems are

• Artificial neural networks

• Genetic algorithms.

What happens at the Back office ?


Example


Outcome -- Expert Recommendation(s)


Automated Results after a careful Evaluation


samples


Challenges with Adoption of CDSS


Word of Caution

• CDSS A Friend, philosopher ,a Guide

NOT a BOSS

• NOT a Substitute for Doctors


Significance

• Quality of Treatment

• Cost

• Patient Safety

• Doctors PAL


Examples for CDSS

• MYCIN one of the first expert systems to be developed in the 1970s,

it does ethological diagnoses of bacterial diseases

• CADUCEUS a medical expert system that could diagnose 1000 diseases.

• Internist-I a computer-assisted diagnostic tool.

• Dxplain One another Dr Explain systems.

• Iliad uses Bayesian reasoning to calculate probabilities of various diagnoses

under consideration in internal medicine. It now covers around 1500 different diagnoses.

• TheraDoc A suite of real-time monitoring products as well as Infection prevention, mediation, and correction. TheraDoc uses a variety of standards compliant messaging taxonomies to work with currently existing software in the clinical setting to guide decision making as well as report trends in problems your institution is encountering.

• Lifecom Lifecom has developed an entirely new form of artificial intelligence technology and a supporting suite of knowledge development tools. The Lifecom technology portfolio includes novel knowledge extraction and management tools, the artificial intelligence engine, and a highly graphical user interface.

• VisualDx point-of-care diagnostic resource that allows clinicians to build patient-centric visual differential diagnoses based on the patient’s signs, symptoms, medical history, and more. Clinicians have immediate access to more than 17,000 images as well as expert-reviewed information for nearly 1,000 visually identifiable diseases, drug reactions, and infections represented in all age ranges and skin types.

• RODIA Relative Optical Density Image Analysis used in medical imaging, medical diagnostics, orthopedic and other medical disciplines.


Life without CDSS


A sample System


Sample continued (1)…


Sample ( Continued …(2)… )


Limitations


• Preliminary evaluation was that changes in care provider practices were based on a single consultation,

• A second potential limitation was the sampling method.

• Risk of Coding , Testing , ( Needless to say …. BA....Role.... )

• Non – Certified CDSS

• NOT sure of a Bulls eye every time

Future of CDSS


What is it built on ?


Some Doc’toons


Questions ?



[email protected]

Sr.Business Analyst

clinical decision support by hari

Health & Medicine