View source for Comparison of Computer-based Clinical Decision Support Systems and Content for Diabetes Mellitus

=Introduction=
According to [http://www.ucsfhealth.org/conditions/diabetes_mellitus/ UCSF] Medical Center, “[http://www.mayoclinic.org/diseases-conditions/diabetes/basics/definition/con-20033091/''Diabetes mellitus''] has become an epidemic in the United States with about 1 million people over age 20 diagnosed with the condition each year. About 17 million people, or 6 percent of the U.S. population, have diabetes mellitus, a disease in which the body doesn't produce or properly use insulin [http://en.wikipedia.org/wiki/Insulin/Insulin], a hormone produced in the pancreas that converts sugar into energy.” It is determined to be the sixth leading cause of death in the United States. It can also “cause serious health complications such as blindness, kidney failure, nerve damage and the need for lower-extremity amputations. In addition, diabetes is a major risk factor for cardiovascular disease, dramatically increasing the risk for heart disease and stroke.” <ref name = " UCSF Medical Center"> UCSF Medical Center. Conditions and Treatment: Diabetes Mellitus. University of California San Francisco. Accessed from http://www.ucsfhealth.org/conditions/diabetes_mellitus/ 03/25/2015./</ref>

Computer-based [http://www.healthit.gov/policy-researchers-implementers/clinical-decision-support-cds/ Clinical Decision Support (CDS)] systems have demonstrated improved quality of care and efficiency of workflows. It has been widely utilized across [http://www.himss.org/library/ehr/ EHRs] in the nation. The Health Information Technology for Economic and Clinical Health Act (HITECH) offered incentive payments to providers and hospitals that implemented [[Meaningful use|Meaningful Use]] by using technology for their Electronic Health record to improve quality and safety.<ref name = " M. Kantor, A. Wright, et. al "> M. Kantor, A. Wright, et. al. Comparison of Computer-based Clinical Decision Support Systems and Content for Diabetes Mellitus.2011. PMC US National Library of Medicine National Institute of Health. Accessed from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3631936/ 03/25/2015./</ref>  “Health care reform legislation relies on electronic health records and [http://www.healthit.gov/policy-researchers-implementers/clinical-decision-support-cds/ CDS] systems to improve the cost and quality of health care in the United States; however, the heterogeneity of [http://www.healthit.gov/policy-researchers-implementers/clinical-decision-support-cds/ CDS] content and infrastructure of [http://www.healthit.gov/policy-researchers-implementers/clinical-decision-support-cds/ CDS] systems across sites is not well known.” <ref name = " M. Kantor, A. Wright, et. al "> M. Kantor, A. Wright, et. al. Comparison of Computer-based Clinical Decision Support Systems and Content for Diabetes Mellitus.2011. PMC US National Library of Medicine National Institute of Health. Accessed from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3631936/ 03/25/2015./</ref>
<ref name="MU">Meaningful Use.http://www.clinfowiki.org/wiki/index.php/Meaningful_use</ref>

== Objective ==
The authors of this study “aimed to determine the scope of [http://www.healthit.gov/policy-researchers-implementers/clinical-decision-support-cds/ CDS] content in diabetes care at six sites, assess the capabilities of [http://www.healthit.gov/policy-researchers-implementers/clinical-decision-support-cds/ CDS] in use at these sites, characterize the scope of [http://www.healthit.gov/policy-researchers-implementers/clinical-decision-support-cds/ CDS] infrastructure at these sites, and determine how the sites use [http://www.healthit.gov/policy-researchers-implementers/clinical-decision-support-cds/ CDS] beyond individual patient care in order to identify characteristics of [http://www.healthit.gov/policy-researchers-implementers/clinical-decision-support-cds/ CDS] systems and content that have been successfully implemented in diabetes care” <ref name = " M. Kantor, A. Wright, et. al "> M. Kantor, A. Wright, et. al. Comparison of Computer-based Clinical Decision Support Systems and Content for Diabetes Mellitus.2011. PMC US National Library of Medicine National Institute of Health. Accessed from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3631936/ 03/25/2015./</ref>

== Methods ==
The authors compared [http://www.healthit.gov/policy-researchers-implementers/clinical-decision-support-cds/ CDS] systems among six collaborating sites of the Clinical Decision Support Group. They gathered [http://www.healthit.gov/policy-researchers-implementers/clinical-decision-support-cds/ CDS] care content from patients with diabetes mellitus then surveyed institutions on the following; characteristics of their site, [http://www.healthit.gov/policy-researchers-implementers/clinical-decision-support-cds/ CDS] Infrastructure and capabilities. <ref name = " M. Kantor, A. Wright, et. al "> M. Kantor, A. Wright, et. al. Comparison of Computer-based Clinical Decision Support Systems and Content for Diabetes Mellitus.2011. PMC US National Library of Medicine National Institute of Health. Accessed from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3631936/ 03/25/2015./</ref>. Data gathered from their survey were carefully evaluated and analyzed for results.

== Results ==
The results revealed that the approach and characteristics of [http://www.healthit.gov/policy-researchers-implementers/clinical-decision-support-cds/ CDS] content characteristics of [http://www.healthit.gov/policy-researchers-implementers/clinical-decision-support-cds/ CDS] content differ from each of the six sites. Commonalities found are the following: providing customizability per user/position, applying sophisticated exclusion criteria, and using automation of [http://www.healthit.gov/policy-researchers-implementers/clinical-decision-support-cds/ CDS] at the time of decision-making. There were several messages that were actionable recommendations. Most of the sites had monitoring rules (e.g. [http://en.wikipedia.org/wiki/Glycated_hemoglobin/hemoglobin A1c]  assessment), but only few sites had rules to diagnose diabetes and or suggest specific treatments. All sites had several [http://www.healthit.gov/policy-researchers-implementers/clinical-decision-support-cds/ CDS] rules in place including reminders for eye examinations, influenza/ pneumococcal vaccines, nephropathy screenings, and lipid screenings. These reminders are generally easier to create but with significant use.

== Comments ==
Based on the knowledge that Diabetes is a very common condition, which can lead to very serious complications, this study caught my attention. The authors did a very great job on their methods used and I am hoping that this study will serve as an eye opener and that healthcare organizations will continue to work on designing and implementing more [http://www.healthit.gov/policy-researchers-implementers/clinical-decision-support-cds/ CDS] Rules that will focus on diagnosing Diabetes and suggest possible treatments as early as possible and more [http://www.healthit.gov/policy-researchers-implementers/clinical-decision-support-cds/ CDS] Rules that will continue to improve patient safety and potentially save several lives.    

== References ==
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[[Category:Reviews]]
[[Category:CDS]]
[[Category:EHR]]