Clinical decision support systems
have been hailed for their potential to decrease medical errors and improve the quality of life for the
patient, it also facilitates evidence-based medicine as a result the health
care services quality have been improved 1.
CDSSs can upgrade
or enhance the physician performance for drug prescribing (dose,
interaction with other drugs or food, route of administration), preventive and
medical care 2
There are a variety of systems that
can potentially support clinical decisions. Clinical decision support system
can be categorized into knowledge
based systems, or nonknowledge based systems.
There are many of Ethical Issues Regarding CDSS especially (who should use
a medical computer program and under what
decision support system (CDSS) define as
software that designed to be a direct aid to clinical decision-making, in which
the characteristics of an individual patient are matched to a computerized
clinical knowledge base and patient-specific assessments or recommendations are
then presented to the clinician or the patient for a decision. 1
Another definition: Clinical
decision support systems (CDSS) are computer systems designed to impact
clinician decision making about individual patients at the point in time that
these decisions are made. 3
clinical decision support
system it’s benefits and advantages (Medication related) 01:
medications can improve the health of patient the process of prescribing the
medications is to complex and error chance is high, this medication errors can cause
many preventable and harmful injuries. CDSS provide many benefits in the
process of prescribing a drug such as:
A-Drug or food Allergy Checking which present as alert with different
color, this allergy list is specific to one certain patient (by electronically
documented allergy) if the allergy checking is inappropriate
or inadequate it can lead to harmful event to the patient, this can be due to
physician missing the alert for any reason or the software is generating to
many alarms that the major one is being ignored. 4
B- Duplicate Therapy Checking: duplicated therapy come in many forms (e.g. prescribing two or more regimens of the same drug, or multiple
regimen with the same effect) this usually happen in case of patient visiting
multiple clinicians and each one prescribing without asking about
previous prescription and drug history, Duplicated therapy can give rise to
serious side effect of the medication. clinical decision support system informs
the health care provider when the patient is already taking the same medication.
C- Drug–Drug Interaction Checking 4
D- Basic Dosing Guidance for Medications 4
A study was conducted in Chicago about epidemiology of prescribing
errors over 60% of prescribing errors involved wrong medication doses or
improper administration 5
CDSS can improve medication dosing
through numerous way A basic,
minimally, intrusive strategy
is to offer the clinician a list of patient appropriate dosing parameters for
each particular drug. 4
decision support system Disadvantages 02:
A study was carried out between
October and December 2005.
The participant were 39 physicians
and one of this study objective is to study potential disadvantages or harms of
decision support system.
were mindful of various
potential threats which they describe it as (‘Does it mean that you are even
more closely tied with the computer, and the patient sits quietly behind your
This mean it can affect the
physician and patient relationship (e.g.losing eye contact with patients)
because the doctor will be facing the computer most of the time, it can also
affect the clinical skills. CDSS aim is to support the health care provider but
some depend on it in their decision this can affect physician negatively
because they will stop using their clinical eye and less physical examination.
decision support system Implementation Barriers 03 :
There are many issues and barriers
in the implementation of CDSS and can be divided
into three categories: Human Factors, organizational
factors, and technical issues.
factors usually are not accounted during the process of planning and evolution
of the project for example clinician who refuse the idea of using computers
skills and typing act as barriers to the success of CDSS
Organizational Factors implementation of CDSS start first by assessment
of its readiness and ability to change, and climate
and culture of the organization.
training of the staff which sometimes require long
time of training ..days to months, as well as the management of any disruption
in established or traditional practice patterns
Factors can be related to the software, flexibility of the software is
important for the Practitioners acceptance of the software 7
Summary and Conclusion
As a summary Clinical
decision support system decrease medical errors and improve the quality of life of the
patient as many studies shown.
the health care provider to prescribe safely with the ability of the software
to check drug-interaction, duplicated therapy, dose of the drug and patient
allergy to food or drugs.
other hand it has some disadvantage like affecting the doctor-patient
relationship and clinical skills of the physician.
barriers stand against the Implementation of CDS such as Human factors,
organizational factors and technical factors.
worldwide the government should help in the implementation of Clinical decision
support system in each health care facilities because they have shown a
magnificent advantage in patient safety and health