Clinical Practice Improvement and Redesign: How Change in Workflow Can Be Supported by Clinical Decision Support

摘要

Research shows that automation is able to improve the quality and safety of care delivered by health care facilities. Recent advances in automation have the potential to improve all aspects of health care delivery, from diagnosis and treatment to administration and billing. Diagnostics have improved with the introduction of higher resolution functional magnetic resonance imaging (fMRI), positron emission tomography (PET), and computed tomography (CT) scans, not to mention advances in laboratory medicine technology for superior analysis of blood, urine, and cultures. Automation used for treatment spans the gamutfrom new infusion devices such as smart IV pumps to surgical technologies such as endoscopic surgical tools, improved lasers, and even surgery assisting robots (e.g., da VinciTM). The rapid pace of automation adoption in U.S. health care organizations will likely continue, owed in part to pressures from the government, purchasing groups, and consumers. 1-7 As a result, many health care organizations are functioning in a state of continuous technological change. Interestingly, the aforementioned diagnostic and laboratory automation is being implemented with relatively little fanfare or controversy. On the other hand, clinical decision support (CDS) automation, which provides clinicians and/or patients with computerized clinical information at the appropriate time and in an understandable format,8 has been heralded as the savior of health care quality and patient safety yet remains controversial.