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Clin Colon Rectal Surg 2013; 26(01): 023-030
DOI: 10.1055/s-0033-1333644
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Clinical Decision Support for Colon and Rectal Surgery: An Overview

Allison B. McCoy
1   School of Biomedical Informatics, The University of Texas Health Science Center at Houston (UTHealth), Houston, Texas
2   UT-Memorial Hermann Center for Healthcare Quality and Safety, Houston, Texas
,
Genevieve B. Melton
3   Institute for Health Informatics, University of Minnesota, Minneapolis, Minnesota
4   Department of Surgery, University of Minnesota, Minneapolis, Minnesota
,
Adam Wright
5   Brigham and Women's Hospital, Boston, Massachusetts
6   Harvard Medical School, Boston, Massachusetts
,
Dean F. Sittig
1   School of Biomedical Informatics, The University of Texas Health Science Center at Houston (UTHealth), Houston, Texas
2   UT-Memorial Hermann Center for Healthcare Quality and Safety, Houston, Texas
› Author Affiliations
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Publication History

Publication Date:
04 March 2013 (online)

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Abstract

Clinical decision support (CDS) has been shown to improve clinical processes, promote patient safety, and reduce costs in healthcare settings, and it is now a requirement for clinicians as part of the Meaningful Use Regulation. However, most evidence for CDS has been evaluated primarily in internal medicine care settings, and colon and rectal surgery (CRS) has unique needs with CDS that are not frequently described in the literature. The authors reviewed published literature in informatics and medical journals, combined with expert opinion to define CDS, describe the evidence for CDS, outline the implementation process for CDS, and present applications of CDS in CRS.CDS functionalities such as order sets, documentation templates, and order facilitation aids are most often described in the literature and most likely to be beneficial in CRS. Further research is necessary to identify and better evaluate additional CDS systems in the setting of CRS.

Keywords

clinical decision support systems - colorectal surgery - electronic health records - patient safety
 

  • References

  • 1 Committee on Quality of Health Care in America, Institute of Medicine. To Err Is Human: Building a Safer Health System. Washington, DC: National Academies Press; 2000
    Google Scholar
  • 2 Committee on Quality of Health Care in America, Institute of Medicine. Crossing the Quality Chasm: A New Health System for the 21st Century. Washington, DC: National Academies Press; 2001
    Google Scholar
  • 3 Bates DW, Cullen DJ, Laird N , et al; ADE Prevention Study Group. Incidence of adverse drug events and potential adverse drug events. Implications for prevention. JAMA 1995; 274 (1) 29-34
    CrossrefPubMedGoogle Scholar
  • 4 Lesar TS, Briceland L, Stein DS. Factors related to errors in medication prescribing. JAMA 1997; 277 (4) 312-317
    CrossrefPubMedGoogle Scholar
  • 5 Bobb A, Gleason K, Husch M, Feinglass J, Yarnold PR, Noskin GA. The epidemiology of prescribing errors: the potential impact of computerized prescriber order entry. Arch Intern Med 2004; 164 (7) 785-792
    CrossrefPubMedGoogle Scholar
  • 6 Reckmann MH, Westbrook JI, Koh Y, Lo C, Day RO. Does computerized provider order entry reduce prescribing errors for hospital inpatients? A systematic review. J Am Med Inform Assoc 2009; 16 (5) 613-623
    CrossrefPubMedGoogle Scholar
  • 7 Ammenwerth E, Schnell-Inderst P, Machan C, Siebert U. The effect of electronic prescribing on medication errors and adverse drug events: a systematic review. J Am Med Inform Assoc 2008; 15 (5) 585-600
    CrossrefPubMedGoogle Scholar
  • 8 van Rosse F, Maat B, Rademaker CMA, van Vught AJ, Egberts ACG, Bollen CW. The effect of computerized physician order entry on medication prescription errors and clinical outcome in pediatric and intensive care: a systematic review. Pediatrics 2009; 123 (4) 1184-1190
    CrossrefPubMedGoogle Scholar
  • 9 Bates DW, Teich JM, Lee J , et al. The impact of computerized physician order entry on medication error prevention. J Am Med Inform Assoc 1999; 6 (4) 313-321
    CrossrefPubMedGoogle Scholar
  • 10 Committee on Quality of Health Care in America, Institute of Medicine. The Computer-Based Patient Record: An Essential Technology for Health Care, Revised Edition. Washington, DC: The National Academies Press; 1997
    Google Scholar
  • 11 Sittig DF, Stead WW. Computer-based physician order entry: the state of the art. J Am Med Inform Assoc 1994; 1 (2) 108-123
    CrossrefPubMedGoogle Scholar
  • 12 Blumenthal D, Tavenner M. The “meaningful use” regulation for electronic health records. N Engl J Med 2010; 363 (6) 501-504
    CrossrefPubMedGoogle Scholar
  • 13 Marcotte L, Seidman J, Trudel K , et al. Achieving meaningful use of health information technology: a guide for physicians to the EHR incentive programs. Arch Intern Med 2012; 172 (9) 731-736
    CrossrefPubMedGoogle Scholar
  • 14 Melton GB. Biomedical and health informatics for surgery. Adv Surg 2010; 44 (1) 117-130
    CrossrefPubMedGoogle Scholar
  • 15 Richardson JE, Ash JS, Sittig DF , et al. Multiple perspectives on the meaning of clinical decision support. AMIA Annu Symp Proc 2010; 2010: 672-676
    PubMedGoogle Scholar
  • 16 Osheroff J, Teich J, Levick D , et al. Improving Outcomes with Clinical Decision Support: An Implementer's Guide. 2nd ed. Chicago, IL: Healthcare Information and Management Systems Society; 2012
    Google Scholar
  • 17 Wright A, Sittig DF, Ash JS , et al. Development and evaluation of a comprehensive clinical decision support taxonomy: comparison of front-end tools in commercial and internally developed electronic health record systems. J Am Med Inform Assoc 2011; 18 (3) 232-242
    CrossrefPubMedGoogle Scholar
  • 18 Kaushal R, Shojania KG, Bates DW. Effects of computerized physician order entry and clinical decision support systems on medication safety: a systematic review. Arch Intern Med 2003; 163 (12) 1409-1416
    CrossrefPubMedGoogle Scholar
  • 19 Kawamoto K, Houlihan CA, Balas EA, Lobach DF. Improving clinical practice using clinical decision support systems: a systematic review of trials to identify features critical to success. BMJ 2005; 330 (7494) 765
    CrossrefPubMedGoogle Scholar
  • 20 Hunt DL, Haynes RB, Hanna SE, Smith K. Effects of computer-based clinical decision support systems on physician performance and patient outcomes: a systematic review. JAMA 1998; 280 (15) 1339-1346
    CrossrefPubMedGoogle Scholar
  • 21 Kuperman GJ, Bobb A, Payne TH , et al. Medication-related clinical decision support in computerized provider order entry systems: a review. J Am Med Inform Assoc 2007; 14 (1) 29-40
    PubMedGoogle Scholar
  • 22 Kaushal R, Jha AK, Franz C , et al; Brigham and Women's Hospital CPOE Working Group. Return on investment for a computerized physician order entry system. J Am Med Inform Assoc 2006; 13 (3) 261-266
    CrossrefPubMedGoogle Scholar
  • 23 Bright TJ, Wong A, Dhurjati R , et al. Effect of clinical decision-support systems: a systematic review. Ann Intern Med 2012; 157 (1) 29-43
    CrossrefPubMedGoogle Scholar
  • 24 Kuperman GJ, Gibson RF. Computer physician order entry: benefits, costs, and issues. Ann Intern Med 2003; 139 (1) 31-39
    CrossrefPubMedGoogle Scholar
  • 25 Chaudhry B, Wang J, Wu S , et al. Systematic review: impact of health information technology on quality, efficiency, and costs of medical care. Ann Intern Med 2006; 144 (10) 742-752
    CrossrefPubMedGoogle Scholar
  • 26 Sirajuddin AM, Osheroff JA, Sittig DF, Chuo J, Velasco F, Collins DA. Implementation pearls from a new guidebook on improving medication use and outcomes with clinical decision support. Effective CDS is essential for addressing healthcare performance improvement imperatives. J Healthc Inf Manag 2009; 23 (4) 38-45
    PubMedGoogle Scholar
  • 27 Berwick DM. Making good on ACOs' promise—the final rule for the Medicare shared savings program. N Engl J Med 2011; 365 (19) 1753-1756
    CrossrefPubMedGoogle Scholar
  • 28 Wright A, Sittig DF, Ash JS , et al. Governance for clinical decision support: case studies and recommended practices from leading institutions. J Am Med Inform Assoc 2011; 18 (2) 187-194
    CrossrefPubMedGoogle Scholar
  • 29 Ash JS, Stavri PZ, Dykstra R, Fournier L. Implementing computerized physician order entry: the importance of special people. Int J Med Inform 2003; 69 (2–3) 235-250
    CrossrefPubMedGoogle Scholar
  • 30 Sittig DF, Wright A, Meltzer S , et al. Comparison of clinical knowledge management capabilities of commercially-available and leading internally-developed electronic health records. BMC Med Inform Decis Mak 2011; 11: 13
    CrossrefPubMedGoogle Scholar
  • 31 Henriksen K, Battles JB, Marks ES, Lewin DI , Eds. Advances in Patient Safety: From Research to Implementation (Volume 3: Implementation Issues). Rockville, MD: Agency for Healthcare Research and Quality (US); 2005. . Available at: http://www.ncbi.nlm.nih.gov/pubmed/21250003 . Accessed: May 29, 2012
    Google Scholar
  • 32 Sittig DF, Singh H. Rights and responsibilities of users of electronic health records. CMAJ 2012; 184 (13) 1479-1483 . Available at: http://www.ncbi.nlm.nih.gov/pubmed/22331971
    CrossrefPubMedGoogle Scholar
  • 33 Kucher N, Koo S, Quiroz R , et al. Electronic alerts to prevent venous thromboembolism among hospitalized patients. N Engl J Med 2005; 352 (10) 969-977
    CrossrefPubMedGoogle Scholar
  • 34 Stutman HR, Fineman R, Meyer K, Jones D. Optimizing the acceptance of medication-based alerts by physicians during CPOE implementation in a community hospital environment. AMIA Annu Symp Proc 2007; 701-705
    PubMedGoogle Scholar
  • 35 Paterno MD, Maviglia SM, Gorman PN , et al. Tiering drug-drug interaction alerts by severity increases compliance rates. J Am Med Inform Assoc 2009; 16 (1) 40-46
    CrossrefPubMedGoogle Scholar
  • 36 Haq Z, Rahman M, Chowdhury RA, Baten MA, Khatun M. Chemical sphincterotomy—first line of treatment for chronic anal fissure. Mymensingh Med J 2005; 14 (1) 88-90
    PubMedGoogle Scholar
  • 37 Chang ML, Hou JK. Cancer risk related to gastrointestinal diagnostic radiation exposure. Curr Gastroenterol Rep 2011; 13 (5) 449-457
    CrossrefPubMedGoogle Scholar
  • 38 Haynes K, Linkin DR, Fishman NO , et al. Effectiveness of an information technology intervention to improve prophylactic antibacterial use in the postoperative period. J Am Med Inform Assoc 2011; 18 (2) 164-168
    CrossrefPubMedGoogle Scholar
  • 39 Nair BG, Newman S-F, Peterson GN, Wu W-Y, Schwid HA. Feedback mechanisms including real-time electronic alerts to achieve near 100% timely prophylactic antibiotic administration in surgical cases. Anesth Analg 2010; 111 (5) 1293-1300
    CrossrefPubMedGoogle Scholar
  • 40 Magid SK, Pancoast PE, Fields T, Bradley DG, Williams RB. Employing clinical decision support to attain our strategic goal: the safe care of the surgical patient. J Healthc Inf Manag 2007; 21 (2) 18-25
    PubMedGoogle Scholar
  • 41 Wright A, Chen ES, Maloney FL. An automated technique for identifying associations between medications, laboratory results and problems. J Biomed Inform 2010; 43 (6) 891-901
    CrossrefPubMedGoogle Scholar
  • 42 Patterson SM, Hughes C, Kerse N, Cardwell CR, Bradley MC. Interventions to improve the appropriate use of polypharmacy for older people. Cochrane Database Syst Rev 2012; 5: CD008165
    PubMedGoogle Scholar
  • 43 Filik R, Purdy K, Gale A, Gerrett D. Labeling of medicines and patient safety: evaluating methods of reducing drug name confusion. Hum Factors 2006; 48 (1) 39-47
    CrossrefPubMedGoogle Scholar
  • 44 Sittig DF, Pace NL, Gardner RM, Beck E, Morris AH. Implementation of a computerized patient advice system using the HELP clinical information system. Comput Biomed Res 1989; 22 (5) 474-487
    CrossrefPubMedGoogle Scholar
  • 45 Claret L, Girard P, Hoff PM , et al. Model-based prediction of phase III overall survival in colorectal cancer on the basis of phase II tumor dynamics. J Clin Oncol 2009; 27 (25) 4103-4108
    CrossrefPubMedGoogle Scholar
  • 46 Farion KJ, Michalowski W, Rubin S, Wilk S, Correll R, Gaboury I. Prospective evaluation of the MET-AP system providing triage plans for acute pediatric abdominal pain. Int J Med Inform 2008; 77 (3) 208-218
    CrossrefPubMedGoogle Scholar
  • 47 Evans RS, Pestotnik SL, Classen DC , et al. A computer-assisted management program for antibiotics and other antiinfective agents. N Engl J Med 1998; 338 (4) 232-238
    Google Scholar
  • 48 Wright A, Feblowitz JC, Pang JE , et al. Use of order sets in inpatient computerized provider order entry systems: A comparative analysis of usage patterns at seven sites. Int J Med Inform 2012; 81 (11) 733-745
    CrossrefPubMedGoogle Scholar
  • 49 Hayman AV, Chang ET, Molokie RE, Kahng LS, Prystowsky JB, Bentrem DJ. Assessing compliance with national quality measures to improve colorectal cancer care at the VA. Am J Surg 2010; 200 (5) 572-576
    CrossrefPubMedGoogle Scholar
  • 50 McCoy AB, Waitman LR, Gadd CS , et al. A computerized provider order entry intervention for medication safety during acute kidney injury: a quality improvement report. Am J Kidney Dis 2010; 56 (5) 832-841
    CrossrefPubMedGoogle Scholar
  • 51 Lo HG, Matheny ME, Seger DL, Bates DW, Gandhi TK. Impact of non-interruptive medication laboratory monitoring alerts in ambulatory care. J Am Med Inform Assoc 2009; 16 (1) 66-71
    CrossrefPubMedGoogle Scholar
  • 52 McDonald CJ, Hui SL, Smith DM , et al. Reminders to physicians from an introspective computer medical record. A two-year randomized trial. Ann Intern Med 1984; 100 (1) 130-138
    CrossrefPubMedGoogle Scholar
  • 53 McPhee SJ, Bird JA, Jenkins CN, Fordham D. Promoting cancer screening. A randomized, controlled trial of three interventions. Arch Intern Med 1989; 149 (8) 1866-1872
    CrossrefPubMedGoogle Scholar
  • 54 Singh H, Kadiyala H, Bhagwath G , et al. Using a multifaceted approach to improve the follow-up of positive fecal occult blood test results. Am J Gastroenterol 2009; 104 (4) 942-952
    CrossrefPubMedGoogle Scholar
  • 55 Chapman JR, Dozois EJ, Wolff BG, Gullerud RE, Larson DR. Diverticulitis: a progressive disease? Do multiple recurrences predict less favorable outcomes?. Ann Surg 2006; 243 (6) 876-830 , discussion 880–883
    CrossrefPubMedGoogle Scholar
  • 56 Moore LJ, Turner KL, Todd SR, McKinley B, Moore FA. Computerized clinical decision support improves mortality in intra abdominal surgical sepsis. Am J Surg 2010; 200 (6) 839-843 , discussion 843–844
    CrossrefPubMedGoogle Scholar
  • 57 Ornstein SM, Garr DR, Jenkins RG, Rust PF, Arnon A. Computer-generated physician and patient reminders. Tools to improve population adherence to selected preventive services. J Fam Pract 1991; 32 (1) 82-90
    PubMedGoogle Scholar
  • 58 Goldberg D, Schiff GD, McNutt R, Furumoto-Dawson A, Hammerman M, Hoffman A. Mailings timed to patients' appointments: a controlled trial of fecal occult blood test cards. Am J Prev Med 2004; 26 (5) 431-435
    CrossrefPubMedGoogle Scholar
  • 59 Mosen DM, Feldstein AC, Perrin N , et al. Automated telephone calls improved completion of fecal occult blood testing. Med Care 2010; 48 (7) 604-610
    CrossrefPubMedGoogle Scholar
  • 60 Miller RA, Waitman LR, Chen S, Rosenbloom ST. The anatomy of decision support during inpatient care provider order entry (CPOE): empirical observations from a decade of CPOE experience at Vanderbilt. J Biomed Inform 2005; 38 (6) 469-485
    CrossrefPubMedGoogle Scholar
  • 61 Koppel R, Metlay JP, Cohen A , et al. Role of computerized physician order entry systems in facilitating medication errors. JAMA 2005; 293 (10) 1197-1203
    CrossrefPubMedGoogle Scholar
  • 62 Hripcsak G, Friedman C, Alderson PO, DuMouchel W, Johnson SB, Clayton PD. Unlocking clinical data from narrative reports: a study of natural language processing. Ann Intern Med 1995; 122 (9) 681-688
    CrossrefPubMedGoogle Scholar
  • 63 Meng F, D'Avolio LW, Chen AA, Taira RK, Kangarloo H. Generating models of surgical procedures using UMLS concepts and multiple sequence alignment. AMIA Annu Symp Proc 2005; 520-524
    PubMedGoogle Scholar
  • 64 Lamiell JM, Wojcik ZM, Isaacks J. Computer auditing of surgical operative reports written in English. Proc Annu Symp Comput Appl Med Care 1993; 269-273
    PubMedGoogle Scholar
  • 65 Wagner JC, Rogers JE, Baud RH, Scherrer JR. Natural language generation of surgical procedures. Int J Med Inform 1999; 53 (2–3) 175-192
    CrossrefPubMedGoogle Scholar
  • 66 Murphy DR, Reis B, Sittig DF, Singh H. Notifications received by primary care practitioners in electronic health records: a taxonomy and time analysis. Am J Med 2012; 125 (2) 209.e 1-7
    PubMedGoogle Scholar
  • 67 van der Sijs H, Aarts J, Vulto A, Berg M. Overriding of drug safety alerts in computerized physician order entry. J Am Med Inform Assoc 2006; 13 (2) 138-147
    CrossrefPubMedGoogle Scholar
  • 68 McCoy AB, Waitman LR, Lewis JB , et al. A framework for evaluating the appropriateness of clinical decision support alerts and responses. J Am Med Inform Assoc 2012; 19 (3) 346-352
    CrossrefPubMedGoogle Scholar
  • 69 McCoy AB, Cox ZL, Neal EB , et al. The comparative effectiveness of real-time pharmacy surveillance and clinical decision support to reduce adverse drug events in acute kidney injury: a randomized, controlled trial. Appl Clin Inform 2012; 3 (2) 221-238
    Article in Thieme ConnectPubMedGoogle Scholar
  • 70 Waitman LR, Phillips IE, McCoy AB , et al. Adopting real-time surveillance dashboards as a component of an enterprisewide medication safety strategy. Jt Comm J Qual Patient Saf 2011; 37 (7) 326-332
    PubMedGoogle Scholar
  • 71 Sittig DF, Wright A, Osheroff JA , et al. Grand challenges in clinical decision support. J Biomed Inform 2008; 41 (2) 387-392
    CrossrefPubMedGoogle Scholar
  • 72 Osheroff JA, Teich JM, Middleton B, Steen EB, Wright A, Detmer DE. A roadmap for national action on clinical decision support. J Am Med Inform Assoc 2007; 14 (2) 141-145
    CrossrefPubMedGoogle Scholar
  • 73 Kawamoto K, Lobach DF. Proposal for fulfilling strategic objectives of the U.S. roadmap for national action on clinical decision support through a service-oriented architecture leveraging HL7 services. J Am Med Inform Assoc 2007; 14 (2) 146-155
    CrossrefPubMedGoogle Scholar