This guide defines CDS as “systems that link health observations with health knowledge to influence health choices by clinicians for improved health care.” These systems are designed to reduce the occurrence of two main remediable flaws in decision-making: errors of omission and errors of commission. The CDS mode may be passive, active or directive and may occur asynchronously or synchronously.
The guide describes several categories of CDS which are summarized in this table.
The report notes that after more than 30 years of high quality research, the evidence is strong that some types of CDS, including simple reminders such as pap smear, influenza immunization and blood sugar prompts, consistently shift behavior. More complex CDS interventions have shown inconsistent results. Dr. Hayward goes on to say:
“Even allowing for all the gaps in studies of CDS, we know enough to state unequivocally that CDS can improve both health processes and outcomes. We also now know that CDS, when mishandled or ignored, can hamper health processes and outcomes. Especially worrisome is the observation that harms happen when clinicians don’t even realize that they are exposed to CDS.”
He concludes: “The greatest immediate impact is more likely to be had from smaller CDS benefits spread over a very large number of providers and patients, as is the case with simple reminders, alerts and references (integrated with medical records) targeting common errors of omission.”
CDS is entrenched in our health information systems and will continue to evolve, and I am reassured that the appropriate tools are being evaluated carefully. Provincial best clinical guidance forms, using these principles, are openly published for all, including our current EMR vendors. The goal is to bring more consistency across our health care system, particularly for health maintenance reminders. Connect Care has licensed high-quality, point-of-care clinical resources which will be seamlessly integrated into that CIS. Our patients stand to benefit significantly from this technology if we, as clinicians, take the time to understand the advantages and limitations of these tools.
Those interested in learning more will find the following links very informative:
CIS Key Concepts: Clinical Decision Support http://handbook.ahs-cis.ca/?=12643
eHealth Literacy module on CDS (including a 30-minute streaming video presentation) http://ehealth-fd.ca/cdm-cds
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