Designing an automated clinical decision support system to match clinical practice guidelines for opioid therapy for chronic pain

This is a review of an article by Trafton et al, Designing an automated clinical decision support system to match clinical practice guidelines for opioid therapy for chronic pain

Background

Opioid prescribing for chronic pain is common but recommended clinical practices are not followed consistently in clinical settings. Increasing adherence to clinical practice guidelines is needed to increase effectiveness and reduce negative consequences for chronic pain patients.

Methods

A computerized Clinical Decision Support (CDS) system is implemented following the 2003 VA/DOD Clinical Practice Guideline for Opioid Therapy for Chronic Non-Cancer Pain. An iterative process of design, testing, and revision involving a diverse team including guideline author, medical informatics experts, clinical content experts, and end-users was used to convert the clinical practice guideline into a CDS system generating patient-specific recommendations for patient care.

Results

Numerous problems were identified from the initially designed system during the iterative revision process. The process of operationalizing the guideline identified areas where the guideline was vague, left decisions to clinical judgment, or requiring clarifications. A multifunctional CDS system integrated into clinical workflow with improved clarity and accuracy was built after these revisions.

Comments

This study developed a CDS system for opoioid therapy to improve compliance with best clinical practice. Although the authors stated great improvements have been achieved during the iterative revision process, it is still not clear how the CDS system affect clinical practice. The authors should have collected data demonstrating clinical utility of the new system.

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