1. Proposed CDS for Colorectal Diseases
CDS Type Examples
Medication dosing support Dosing advisor for antibiotics based on renal function
Order facilitators – Subsequent or corollary
orders
Order liver function tests with azathioprine
Order hemoglobin test with mesalamine
Order facilitators – Transfer order set Transfer to surgery step-down unit order set
Order facilitators – Procedure-specific order set Post-operative colectomy order set
Point of care alerts/reminders – Drug-condition
interaction checking
Alert when a provider orders flagyl for a female patient of childbearing age
Point of care alerts/reminders – Ticklers Alert a provider when colonoscopy has been ordered but not scheduled or
performed within three months
Expert systems – Prognostic tools Estimate survival for cancer patients based on tumor grade and stage
Workflow support – Order approvals Send all colonoscopy orders to CRS for approval
Workflow support – Documentation aids Structured documentation template for a CRS visit that has common findings
Allison B. McCoy, PhD and Dean F. Sittig, PhD
School of Biomedical Informatics, The University of Texas Health Science Center at Houston (UTHealth),
UT Houston-Memorial Hermann Center for Healthcare Quality and Safety, Houston, TX
Computer-Based Clinical Decision Support for Colorectal Diseases:
An Overview of Barriers and Facilitators
Purpose
To describe the use of clinical decision support (CDS)
within healthcare information technology systems to
improve care of patients with colorectal diseases.
Conclusions
Further research is necessary to develop and optimize
CDS alerts for preventive and follow-up care, and to
identify additional patient care scenarios where new
interventions can benefit patients with colorectal
diseases.
Existing CDS for Colorectal Diseases
CDS Type Examples
Point of care alerts/reminders – Care reminders Reminder providers to order a yearly FOBT for patients between 45 and 85
McDonald C. Ann Intern Med (1984), McPhee S. Arch Intern Med (1989)
Point of care alerts/reminders – Critical
laboratory value checking
Notify providers about positive FOBT results
Singh H. Am J Gastroenterol (2009)
Expert systems – Diagnostic support Perform natural language processing to determine time and status of
colonoscopy testing
Denny J. J Am Med Inform Assoc (2010)
Workflow support – Registry functions Send a letter to all patients to recommend FOBT
Ornstein S. J Fam Pract (1991), Goldberg D. Am J Prev Med (2004), Mosen D. Med Care (2010)
Notify all patients with an expired colonoscopy order
Cameron A. Arch Int Med (2010)
Methods
The authors reviewed published literature in informatics
and medical journals, combined with expert opinion, to
summarize relevant prior work.
Results
In the setting of colorectal diseases, alerts most often
prompt primary care clinicians to order or remind patients
about cancer screening tests or to follow up with patients
after abnormal screening test results. These reminders
can increase the rate at which screenings and follow-ups
are performed, potentially decreasing the incidence and
mortality of colorectal diseases.
Noisy Alerts
Frequent Provider
Overrides
Provider Non-Adherence
Delivery to the Right
Person
Effective Workflow
Integration
High Algorithm Specificity
Informative Notifications
Complete, Accurate
Triggering Data
Methods for Overcoming Clinical Decision Support Barriers
Sittig DF, Singh H. Eight rights of safe electronic health record use. JAMA 2009;302(10).
McCoy AB, Waitman LR, Lewis JB, et al. A framework for evaluating the clinical impact of computerized medication safety alerts. J Am Med Inform Assoc (Under Review).
Wright A, Sittig DF, Ash JS, et al. Development and evaluation of a comprehensive clinical decision support taxonomy: comparison of front-end tools in commercial and
internally developed electronic health record systems. J Am Med Inform Assoc. 2011;8(3).
Irrelevant Information