COSMIC Clinical Decision Support

Computer-based Clinical Decision Support (CDS) can be defined as the use of the computer to link relevant knowledge to patient specific information to facilitate decision making at the point of care. There is paramount evidence that CDS can improve patient safety and facilitate evidence-based medicine. The most effective way of providing CDS is within an Electronic Health Record System (EHR), e.g. Cambio COSMIC, where diagnoses, results and treatments are documented and different kinds of orders are planned and performed.

The Need for CDS and Feedback

It is well known that it takes many years for evidence-based best practice to become widely used at the point of care. This is due to the long and mostly manual process of spreading knowledge to and changing the practice of medical professionals as well as the lack of feedback on how the guidelines are followed and for what reasons, good or bad, there are deviations in clinical practice. Currently the main feedback loop in Sweden, which is based on integrations between EHR systems and quality registries, is not only slow and ineffective but also inaccurate due to manually repeated data entries.

Cambio’s CDS Solutions

Our CDS solution is based on the direct use of EHR information for real time feedback in the form of quality indicators and guideline compliance checking. The clinical knowledge is fully computerised as rules, using common EHR models based on international standards and reference terminologies, in our CDS Workbench so the clinical rules can be shared freely across organizations and country borders. Visually appealing diagrams from our Clinical Performance Dashboard is driven by clinical rules on production data from the EHR for real-time feedback in order to identify, monitor and compare clinical performance on regional level or across units and specialities. Once certain clinical gaps are identified, the same computerized rules used for monitoring can be introduced into the EHR system for Real-time CDSintervention in the form of reminders, alerts and order-sets. Once real-time CDS applications are deployed, they can be continuously monitored for performance over time. The compliance information as well as reasons for deviations will generate valuable input to guideline authors for future updates of the clinical knowledge.

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