DNP 801 Topic 6 DQ2

DNP 805 Topic 3 Discussion 2 Select a particular medication or clinical problem. Describe how the CPOE and/or CDSS technologies support care decisions in this area. Numerous patients live with the complications of chronic obstructive pulmonary disease (COPD). Those living with this chronic condition experience multiple ED admissions and hospitalizations to manage their symptoms. As such it is important for physicians and other practitioners to utilize information technology to enhance the treatment regimen for these individuals. Clinical decision support systems (CDSS) is software that is designed to be a direct aid to the clinical decision-making process where patient characteristics are aligned to a computerized knowledge base and patient-centered assessments or recommendations are presented to the clinician and/or the patient for a decision (Velickovski et al., 2014). This technology can help to close the gap between evidence-based practice and the clinical care delivered to the patient. To address this gap, the CDSS should deliver fast and reliable recommendations to the clinician while minimizing the impact to existing workflows. For successful adoption of this technology, one must consider the design of the architecture. Stand-alone models has no integration to an external health information system (HIS) or electronic health record(EHR) and requires the user to enter all findings and clinical information which is very time consuming (Velickovski et al., 2014). However, this design is shareable and transferrable. Integrated models is coupled to the HIS or EHR, makes less input demands on the user, and is proactive in issuing alerts (Velickovski et al., 2014). A drawback to this model is the difficulty in sharing information as it is dependent on a specific HIS or EHR. Standard-based models separates the CDSS from the HIS and EHR. Interoperability is achieved by standardizing of the computerized representation of clinical information (Velickovski et al., 2014). Service-oriented models separates the CDSS from the HIS but then integrates them using standardized, service-based interfaces which encodes the clinical data and advice in a formal representation using ontologies and vocabularies (Velickovski et al., 2014). In the research article by Velickovski et al., the authors sought to utilize CDSS in preventive management of COPD. They used this technology to better identify occult COPD cases to determine and delineate a more natural history of the disease. This research is based on the Global Initiative for COPD recommendations for management of this disease through targeted assessment of the patient’s symptoms, future risk of exacerbations, severity of the abnormalities in spirometry testing, and identification of co-morbidities (Vestbo et al., 2013). To incorporate these recommendations into the treatment paradigm, CDSS was utilized. This resulted in a richer stratification of the patient population as well as inclusion of new knowledge from the initiative. Moreover, this technology acts as a complement to existing policies of integrated care for COPD. CDSS is able to issue recommendations that have a high degree of accuracy to support COPD case-finding while allowing a more seamless transition into existing workflows and enhancing the connections to HIS already in use. Velickovski, F., Ceccaroni, L., Roca, J., Burgos, F., Galdiz, J.B., Marina, N., & Lluch-Ariet, M. (2014). Clinical decision support systems (CDSS) for preventive management of COPD patients. Journal of Translational Medicine, 12(2), 1-10. doi: 10.1186/-S2-S9 Vestbo, J., Hurd, S.S.S., Agusti, A.G., Jones, P.W., Vogelmeier, C., Anzueto, A., Barnes, P.J., Fabbri, L.M., Martinez, F.J., & Nishimura, M. (2013). Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: Gold executive summary. American Journal of Respiratory and Critical Care Medicine, 187(4), 347-365. doi: 10.1164/rccm.-0596PP