Question 1

Why have most clinical decision support (CDS) systems not shown to significantly impact patient outcomes in clinical trials, despite the fact that a majority of systems have been shown to significantly improve care processes?

A) CDS systems have not been evaluated in clinical trials.
B) Very few studies have assessed the impact of CDS systems on patient outcomes.
C) Many CDS system evaluation trials are underpowered to detect changes in care outcomes.
D) CDS systems have been implemented and evaluated in too many diverse institutions.

Many CDS system evaluation trials are underpowered to detect changes in care outcomes.

Accepted Answer

The sample sizes of many CDS system evaluation studies were too small or conducted with too short of a time period to detect changes in care outcomes.

Question 2

Which group would have a financial incentive to implement CDS?&#10;A) A community hospital&#10;B) An inner-city clinic&#10;C) A national insurer&#10;D) Depends on CDS and healthcare payment model

Accepted Answer

Whether a particular stakeholder group has a financial incentive to implement CDS depends on the specific CDS under consideration and the governing healthcare payment model in place.

Question 3

A healthcare system has implemented a functionality where patients who are overdue or almost due for a mammogram are sent letters notifying them to schedule a mammogram based on available data and current clinical care guidelines. Which type of CDS system is this?

A) This is not a CDS.
B) A personal health record system
C) A reminder system
D) An alerting system

A reminder system

Accepted Answer

This is a classic example of a reminder system. Patients are also potential targets of CDS interventions.

Question 4

Which statement is not part of the Ten Commandments of CDS?&#10;A) Speed is everything.&#10;B) Fit into the user's workflow.&#10;C) Alerting is the most effective approach to CDS.&#10;D) Ask for additional information only when you really need it.

Accepted Answer

The Ten Commandments of CDS include speed is everything, fit into the user's workflow, and ask for additional information only when you really need it. Alerting may not be the most effective approach to CDS as it may cause alert fatigue, so it is not one of the Ten Commandments of CDS.

Question 5

Which incentive has the strongest potential to spur the nationwide adoption of advanced CDS?&#10;A) Freely available CDS knowledge in a machine-executable form&#10;B) Significant government funding for research efforts to share CDS&#10;C) Shift of healthcare payment from a fee-for-service model to approaches rewarding the delivery of better quality and outcomes at lower cost&#10;D) Meaningful Use Stage 1 requirements related to CDS

Accepted Answer

All of these are important elements encouraging nationwide adoption of advanced CDS. However, as discussed in the chapter, the shift of healthcare payment from a fee-for-service model to approaches rewarding the delivery of better quality and outcomes at lower cost appears to have the strongest potential for change.

Question 6

Which tools are examples of CDS? (Select all that apply.)&#10;A) An order set&#10;B) A reminder&#10;C) A phone call&#10;D) An infobutton&#10;E) An expert system

Accepted Answer

Despite CDS often being limited to alerts and reminders, an order set, a reminder, an infobutton, and expert systems are also examples that represent CDS types. A phone call is not a type of CDS.

Question 7

Why is CDS important for healthcare institutions? (Select all that apply.)&#10;A) It can reduce the need for registered nurses.&#10;B) It can help reduce medical errors.&#10;C) It is a required element of Meaningful Use regulations.&#10;D) It can help improve care value.&#10;E) It can slow the growth in use of facilities to manageable levels.

Accepted Answer

CDS is important on multiple levels. CDS has been found to reduce medical errors, is required as part of Meaningful Use, and has the potential to improve the value of care. CDS have not been found to reduce the need for registered nurses, nor have they been tested for impact on facility use.

Question 8

Why are expert diagnostic decision support systems not integrated into clinical settings? (Select all that apply.)&#10;A) They have not been shown to be comparable to the performance of human experts.&#10;B) Clinicians generally must go out of their routine workflows to use the systems, and these systems generally require time-consuming data entry.&#10;C) There are limited financial incentives to use such systems.&#10;D) The systems have been found to be detrimental to patient care.&#10;E) The software has been shown to be insecure.

Accepted Answer

There has been a lot of attention and promise on diagnostic decision support systems, including trials showing how they could outperform clinician experts. However, as discussed in other sections of the chapter, systems that are misaligned with the clinician's workflow and limited financial incentives are reasons for limited use of diagnostic CDS systems. Diagnostic CDS can be comparable to human experts when used appropriately. Also, these systems have not been found to be detrimental to patient care, nor have out-of-the-ordinary security concerns been shown.

Question 9

Which of the following are challenges or barriers to CDS adoption? (Select all that apply.)&#10;A) Lack of evidence of CDS effectiveness&#10;B) Misaligned financial incentives&#10;C) Inadequate EHR adoption&#10;D) Lack of widely adopted standards for CDS&#10;E) Concerns over &#34;cookbook medicine&#34;

Accepted Answer

All of the choices except lack of evidence of CDS effectiveness are challenges or barriers to CDS adoption. There is evidence to suggest that CDSs are effective. Misaligned financial incentives, inadequate EHR adoption, a lack of widely adopted standards for CDS, and a concern over CDS as "cookbook medicine" are challenges and barriers to adoption.

Question 10

Which of the following practices are included in the CDS Five Rights? (Select all that apply.)&#10;A) Providing the right information&#10;B) Providing to the right person&#10;C) Providing at the right point in the workflow&#10;D) Providing the right reference information&#10;E) Using the right intervention format

Accepted Answer

The CDS Five Rights include providing the right information to the right person at the right point in the workflow, using the right intervention format. Providing applicable reference information has been suggested by others to be a potential best practice for CDS. However, it is not one of the CDS Five Rights.

Deck 10: Clinical Decision Support Systems in Healthcare