Clinical Decision Support Systems

In the chapter we are presenting the theoretical background, state of the art and modern research trends of Clinical decision support systems (CDSS). The challenges for success are derived and our experience is described with the presentation of a good practice example of employing CDSS in telemedicine. CDSS systems are increasingly often integrated into telemedicine clinical practice. In addition to using the same resources, namely digitally coded clinical data, CDSS systems are able to enhance the quality of telemedicine services in many cases. CDSS are computer applications that are designed to help health-care professionals with making clinical decisions about individual patients (Shortliffe and Cimino 2006; Berner 2007). In other words, CDSS are active knowledge systems, which use two or more items of patient data to generate case-specific advice (Wyatt and Spiegelhalter 1991). These kinds of software use relevant knowledge, rules within a knowledge base and relevant patient and clinical data to improve clinical decision making on topics like preventive, acute and chronic care, diagnostics, specific test ordering, prescribing practices (National Electronic Decision Support 2003; Pearson, Moxey et al. 2009). A CDSS correlates data about patient traits with a trustworthy knowledge base to guide a clinician with patient-specific advice, assessments or recommendations. Clinicians, health-care staff or patients can manually enter patient characteristics into the computer systems; alternatively, electronic medical records (EMR) can be queried for retrieval of patient characteristics. These kinds of decision-support systems allow the clinicians to spot and choose the most appropriate treatment. Provided decision-support is based on processes of sophisticated outcomes assessment and algorithms that use knowledge bases to inquire after the newest developments about best practice (Remmlinger 2002; Garg, Adhikari et al. 2005). Regardless of how we choose to define CDSS, we have to accept that the field of CDSS is rapidly advancing and unregulated. It has a potential for harm, if systems are poorly designed and inadequately evaluated, as well as a huge potential to benefit, especially in health care provider performance, quality of care and patient outcomes (Delaney, Fitzmaurice et al. 1999; Pearson, Moxey et al. 2009).