With CDS, familiarity with the system breeds greater acceptance

A study from The Netherlands found that cardiologists and nurses have preconceived ideas about using a clinical decision support system (CDS) for treating heart failure patients, but those biases subside as they learn more about the system's capabilities and limitations.

The CDS system is designed to improve adherence to best practices for heart failure patients. The study, published at BMC Medical Informatics and Decision Making, echoes a previous report in the journal that found that applying clinical practice guidelines at the point of care with EHRs will require the use of CDS and effective translation of evidence to practice.

The researchers surveyed cardiologists and heart failure nurses in three areas: their ability to take responsibility for care and trust the system; perceived barriers and threats; and knowledge management.

On responsibility and trust, 65 percent of respondents said they believe the CDS system can make mistakes. Ninety percent stated that advice of a CDS should always be checked. Seventy-nine percent stated that they are responsible for the treatment of "their" patients and not the CDS. Eighty percent, however, said they believe the CDS offers helpful advice.

The perceived barriers included the time to use the system can be time taken away from patients (75 percent). Eighty percent were not sure a system specifically for heart failure patients would be helpful. Seventy percent were not sure whether taking advice from a computer system led patients to take them less seriously.

On knowledge management, 60 percent said the insight from the CDS added value to treatment. Eighty percent said it added to their own knowledge. Forty percent said the CDS helped them prescribe the optimal dose of medication.

There were no significant differences overall when responses of cardiologists and nurses were compared, though more years of computer experience among nurses increased their trust in the system and knowledge.

Researchers from the University of Rochester (N.Y.) School of Medicine & Dentistry say an interactive dashboard can make working through a complicated decision problem more efficient.

Meanwhile, the Lehigh Valley Health Network in Pennsylvania reports that CDS alerts generated to advise physicians that a test on heart failure patients already had been performed helped it reduce unnecessary testing by 21 percent and save approximately $92,000 a year.

To learn more:
- read the study


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