Integrated clinical decision support : assessing opportunities and outcomes

Abstract

Medical calculators play an important role as a component of specific clinical decision support (CDS) systems that synthesize measurable evidence and can introduce new medical guidelines and standards. Understanding the features of calculators is important for calculator adoption and clinical acceptance. Some medical calculators can fulfill the role of CDS for Meaningful Use purposes. However, there are barriers for clinicians to use medical calculators in practice. This research presents a novel classification system for medical calculators and explores clinician use and perceived usefulness of medical calculators. Additionally, we examine the effects of an EHR integrated decision support tool on management of pain in an inpatient setting. Metadata on 766 medical calculators implemented online were collected, analyzed, and categorized by their input types, method of presenting results, and advisory nature of those results. Reference rate, publication year, and availability of references were collected. We surveyed a population of resident and attending physicians at a medium-sized academic medical center to discover the prevalence of medical calculator use, how they were accessed, and what factors might influence their use, for example, EMR integration. We also conducted a retrospective evaluation of an EHR integrated CDS module focused on pain management, leveraging a novel approach to digital workflow evaluation within the EHR, focusing on patient-centric outcome measurements.