Study: Decision-support systems must be flexible, adaptable, transparent

With the coming Meaningful Use Stage 3 requirements to require greater use of clinical decision support systems, a review of such systems and their use outside healthcare seems particularly apt for looking at lessons learned.

The results are published at BMC Medical Informatics and Decision Making. The researchers were looking for insights that could be generalized to healthcare provider decisions.

From five databases in the basic sciences, social sciences, humanities, engineering, business, and defense--PsychINFO, BusinessSource Premier, Social Sciences Abstracts, Web of Science, and Defense Technical Information Center--the researchers found 890 papers. That number was pared to 27 based on two criteria: 1) that the article provided a review, overview, discussion of lessons learned, or an evaluation of design or implementation aspects of the system, and 2) that it required individual human judgment, not only automated decisions or decisions made at the organizational level. 

Of the 27 references, nine came from the defense industry, two from business, one from law and 15 from decision science generally.

"Clinical decisions share some similarities with decisions made by military commanders, business managers, and other leaders: they involve assessing new situations and choosing courses of action with major consequences, under time pressure, and with incomplete information," wrote the authors, according to the abstract.

From the literature, they noted seven design features that could be applied to clinical decision support: providing broad, system-level perspectives; customizing interfaces to specific users and roles; making the decision-support reasoning transparent; presenting data effectively; generating multiple scenarios covering disparate outcomes; allowing for contingent adaptations; and facilitating collaboration.

In addition, the systems must be able to explore multiple assumptions and to incorporate new information as circumstances change, according to the study. The articles also stressed the importance of creating an organizational culture for success and providing adequate training on the system.

In a similar vein, British researchers are working to adapt technology from aviation to provide real-time monitoring and analysis of heart surgery patients for early signs of complications.

A survey by Black Book Rankings found that clinical decision support systems will be the highest priority for hospital IT leaders--particularly those in developing accountable care organizations--over the next 12 months.

Yet a study funded by the Agency for Healthcare Research and Quality recently reported that despite increasing emphasis on clinical decision-support systems for improving care and reducing costs, evidence to support widespread use is lacking.

To learn more:
- read the study (.pdf)
- here's the abstract