Advanced Search Abstract Objective To illustrate ways in which clinical decision support systems CDSSs malfunction and identify patterns of such malfunctions. We also conducted a preliminary survey of Chief Medical Information Officers to assess the frequency of such malfunctions. Discussion CDSS malfunctions are widespread and often persist for long periods. The failure of alerts to fire is particularly difficult to detect.
Open in a separate window For the effects of the CDSS, we collected pre-intervention data to capture 12 months April to March of information on maternal health routine services before computer-assisted CDSS implementation and the post-intervention captured 12 months April to March of data after computer-assisted CDSS implementation.
The health centres have books that there record maternal health services provided. We therefore reviewed these books or registers at the health centres and collected data on the number of antenatal consultations, labour cases, deliveries, referrals due to complications during ANC visits as well as labour referrals due to complications.
We also collected information on maternal mortality that occurred at the study health centres during the study period. Data processing and analysis The data were entered, cleaned and analyzed using excel. An ingredients approach where quantities of the resources are multiplied by their unit prices was used to calculate costs.
Costs were categorized into personnel, trainings, overheads costs representing recurrent costs and equipment costs representing capital cost.
Costs of implementation were further grouped into two phases. The first phase was referred to as the pre-intervention phase. This first phase was defined as all activities and associated costs that occurred before computer-assisted CDSS was commenced for patient care October to March period.
The second phase was referred to as the intervention phase and included all the activities and associated costs incurred during the 12 months period of actual use of computer-assisted CDSS for patient care April to March The cost of implementation was calculated by adding the pre-intervention costs and intervention costs.
We calculated cost without annualizing capital cost to represent financial cost of the implementation and cost with annualizing capital costs to allow differential timing of capital costs to represent economic cost. Personnel costs were calculated by summing the cost incurred on staff involved in the computer-assisted CDSS intervention during the 12 months period of actual use of computer-assisted CDSS for patient care.
A technical officer with knowledge in information technology IT provided trainings and technical support to the computer-assisted CDSS users. The officer visited the computer-assisted CDSS users fortnightly to monitor and supervise them. The technical officer also downloaded data captured in the computer-assisted CDSS and updated antivirus during the monitoring visits.
In addition, whenever a computer-assisted CDSS user moves transfer, study leavethe officer trains a new user to continue the use of the computer-assisted CDSS. The total cost of the technical officer was therefore calculated by multiplying number of months worked by the monthly allowance.
Not all staff at the health centres were trained to use the CDSS. At least two nurses were trained in each health centre. Each health centre had at least one midwife. All the midwives in the health centres were trained. These additional nurses were selected in consultation with the in-charges of the study health centres.
The basic criteria for selection of these additional nurses for the training were based on their involvement in the provision of antenatal care and delivery in the health centre. Whenever a midwife was transferred or on annual leave or left for further studies, a new person was trained on time for replacement.
The staff that were not selected and trained to use the CDSS carried out their normal duties.View THR's Clinical Decision Support case study. HIMSS Davies Award of Excellence winner Mount Sinai Medical Center leveraged Clinical Decision Support functionality to provide predictive screening alerts relating to many areas including early identification of sepsis cases.
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Original Article How doctors make use of online, point-of-care clinical decision support systems: a case study of UpToDate©.
Feb 19, · Clinical decision support systems (CDSSs) have been hailed for their potential to reduce medical errors 1 and increase health care quality and efficiency. 2 At the same time, evidence-based medicine has been widely promoted as a means of improving clinical outcomes, where evidence-based medicine refers to the practice of medicine based on the best available scientific evidence.
Clinical decision support (CDS) provides timely information, usually at the point of care, to help inform decisions about a patient's care.
CDS tools and systems help clinical teams by taking over some routine tasks, warning of potential problems, or providing suggestions . Clinical decision support system (CDSS) Clinical decision support (CDS) provides clinicians, staff, patients or other individuals with knowledge and person-specific information, intelligently filtered or presented at appropriate times, to enhance health and health care.