The Role of Cognitive Engineering in Improving Clinical Decision Support

2014 ◽  
pp. 22-41
Keyword(s):  
Decision Support ◽  
Clinical Decision Support ◽  
Clinical Decision ◽  
Cognitive Engineering

scholarly journals The Role of Computerized Clinical Decision Support in Reducing Inappropriate Medication Administration During Epidural Therapy

2017 ◽  
Vol 53 (3) ◽  
pp. 170-176
Author(s):  
Jonathon D. Pouliot ◽  
Erin B. Neal ◽  
Bob L. Lobo ◽  
Fred Hargrove ◽  
Rajnish K. Gupta
Keyword(s):  
Decision Support ◽  
Clinical Decision Support ◽  
Epidural Anesthesia ◽  
Statistical Significance ◽  
Inappropriate Medication ◽  
Group Versus ◽  
Implementation Strategies ◽  
Clinical Decision ◽  
Medication Administration

Background: The use of epidural anesthesia has been shown to improve outcomes in the postoperative setting. To minimize risk of complications, avoiding certain medications with epidural anesthesia is advised. Objective: This study sought to determine the role of a computerized clinical decision support module implemented into the computerized physician order entry (CPOE) system on the incidence of administration of medications known to increase complications with epidural anesthesia. Methods: This study was a retrospective cohort chart review in adult patients receiving epidural anesthesia for at least 1 day. Patients were identified retrospectively and divided into 2 cohorts, those receiving an epidural 3 months prior to initiation of the module and those receiving an epidural 3 months following implementation. The primary end point was incidence of inappropriate medication administration before and after implementation. Complications of therapy were collected as secondary end points. Results: There was a reduction in the incidence of inappropriate medication administration in the postimplementation group versus the preimplementation group (6.3% vs 12.8%) although statistical significance was not achieved. In addition, the incidence of enoxaparin administration was significantly lower postimplementation than the preimplementation (0% vs 3.9%). There were no significant differences in other complications of therapy. Conclusions: This study demonstrated that application of decision support for this high-risk procedural population was able to eliminate the incidence of the most common inappropriate medication for epidural analgesia, enoxaparin. A reduction in incidence of other inappropriate medications was also observed; however, statistical significance was not reached. The use of computerized clinical decision support can be a powerful tool in reducing or ameliorating medication errors, and further study will be required to determine the most appropriate and effective implementation strategies.

scholarly journals Genomic decision support needs in pediatric primary care

2017 ◽  
Vol 24 (4) ◽  
pp. 851-856 ◽  
Author(s):  
Jeffrey W Pennington ◽  
Dean J Karavite ◽  
Edward M Krause ◽  
Jeffrey Miller ◽  
Barbara A Bernhardt ◽  
...  
Keyword(s):  
Primary Care ◽  
Decision Support ◽  
Clinical Decision Support ◽  
Clinical Decision ◽  
Primary Care Providers ◽  
Pediatric Primary Care ◽  
Care Providers ◽  
Further Development

Abstract Clinical genome and exome sequencing can diagnose pediatric patients with complex conditions that often require follow-up care with multiple specialties. The American Academy of Pediatrics emphasizes the role of the medical home and the primary care pediatrician in coordinating care for patients who need multidisciplinary support. In addition, the electronic health record (EHR) with embedded clinical decision support is recognized as an important component in providing care in this setting. We interviewed 6 clinicians to assess their experience caring for patients with complex and rare genetic findings and hear their opinions about how the EHR currently supports this role. Using these results, we designed a candidate EHR clinical decision support application mock-up and conducted formative exploratory user testing with 26 pediatric primary care providers to capture opinions on its utility in practice with respect to a specific clinical scenario. Our results indicate agreement that the functionality represented by the mock-up would effectively assist with care and warrants further development.

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