COMPUTER-BASED DECISION SUPPORT IN

HEALTHCARE

1. ABSTRACT
Today medical science had been revolutionized by computer science technology and
computers had become vital part in medical world. Some of task performs that had been
perform by physician had been take care by computer with complex program e.g. artificial
intelligence. This had reduce burden that had been carry physician and nurse, with this
technology more time can be spare by medical staff to monitor patients and gathering data
from them. This paper will review and discuss the issue related to computer-based decision
support that also known as clinical decision support system (CDSS) in healthcare. The issue
will focus on the implementation, system, cost, workload, efficiency, limitation and medical
staff. It will also discuss how they are helpful in taking over medical staff role in treating
patients. The purpose of this research is to examine the aspects of CDSS and to research the
optimal methodology that can be utilized in CDSS to provide better solutions and diagnosis
for medical problems. The research will contain reviewing, reading and understanding of the
others research works and to get better definition. The paper will also recommend options
that can be consider improving CDSS implementation in healthcare industry.

2. INTRODUCTION

Nowadays most patients are treated by physician under professional health care support.
Health care is the treatment, management and prevention of pain and illness with main
objective is to give perfect and compelling administrations that prompt the protection of
mental and physical of people and creatures life. Currently health care is facing problems by
expanding measures of clinical information for every patient treated and increasing volume of
relevant medical research, analyzing this information can lead physician facing pressure and
prone to an error while treating patients. Therefore due to this the development of clinical
information systems had been further researched that included, Health care assignment,
healthcare administration control, rivalry, and health care choice making. Electronic records
and databases can offer doctors some assistance with managing patients information and
provide patient specific information and with clinical decision support systems
recommendation can enhance decision making and guarantee safety of the patient through
significantly decreasing in medical errors, increasing health care quality and efficiency.
Healthcare decision support system also known as Clinical decision support system (CDSS)
from healthcare perspective define as CDSS programming that created to be a provide aid to
healthcare decision, where data of an patient are coordinated to a digital healthcare
knowledge data and patient appraisals or proposals are then provide to the physician or the
patient for decision purpose [1]. This means that patients data collected and scanning into the
database to get the same match that in the end will provide a result for the physicians in terms
of patients sickness condition and recommendations on how to cure to sickness. CDSS is
advance software that dependent on the model or methodology that is used to design the
system. The system currently can be developed based on three approaches, Clinical
algorithms, mathematical, computational approaches and heuristics approaches.
As health care is a knowledge driven and information dependent activity. Modern health care
practice must be reengineered to take into consideration of the advancement in knowledge
and practice of clinical sciences, management science, and information and communications
technology [2]. The CDSS system is based on two types of information assist user in making
decision with objective to assuming control a portion doctor schedule tasks, cautioning
clinicians of possibility problems, alternately giving suggestions to clinician attention. This
kind of knowledge known as knowledge-based and non-knowledge. CDSS that based on
knowledge is based on three segments, this systems is an inference engine and mechanism
design to communicate with user.

As the systems running as per coding programmed and association with compiled database in
the form if then rules. Another type the non-knowledge based CDSS is based on artificial
intelligence (AI). The AI running by reading and learning from the past experiences and find
patterns patients clinical data.

3. LITERATURE REVIEW

Carayon and Osheroff have stated that, evaluations of CDSS ought to evaluate whole
conditions and all persons in interests and not just focusing on performance framework [3].
In the same time both of them also had an acronym METRIC defined as Measure
Everything That Really Impacts Customers. Those CDSS person in interests would indeed a
group of stakeholders which incorporate clinicians, patients, and the association. However
Friedman had other opinion which recommends the use of the terms small ball evaluation,
where an assessment of procedure that had been implemented, client satisfaction, and other
reason that may influence and connected to the result of intercession [3].
Another writer had made an argument; Kaplan had said that there must be qualitative
assessments that evaluate the person-CDSS interaction and its impact on the health care, the
procedure, and other authorize procedures and result [3]. There are writers who had question
about how CDSS had enhanced patient health care? this subjective question had been
answered by M.Pusic and J.M.Asermino that Outlining useful evaluative trials will be was
troublesome and the sheer mixed bag about frameworks and also capacities makes
examination muddled[4] and based their study had foreseen that physician or patient
compliance with proved based suggestions enhanced from 52% to 57% with CDSS [6].
Seven out about eight important deliberate reviews had show result a certain positive impact
on stakeholder behavior. However it must be noted here that the review had excluded the
computer-generated reminders.
Ralph Engle also had make an argument that Our experience confirms those great challenge
that could be impossible, for incorporating the intricacy of the human thought under an
arrangement that can be take care by system. [5]. We come to conclusion that we must put to
end trying to make a system act like a physician and focus rather than find ways to make
system provide data and information for user decisions This show that Ralph Engle had
opposed CDSS and rather than use CDSS as diagnostic tools it should be as use as a tools to
generate information that will assist user in making decision. This opinion almost coherent
with Carayon, et al. and Osheroff ,et al that had urged CDSS should be focus on work
situation rather than performance system.

4. DISCUSSION

Each technology had their own cost incurred to ensure the success in researching and
implementing the technology. There is nothing free in modern world environment. CDSS
which is highly complex technology architecture and based on highly complex algorithms
calculation had costing millions of dollar or probably billion to make it use just in one
country. As CDSS involve with human life by assisting physician to make related to the
patients life, therefore the cost is worth to absorb by the sponsor which is most likely
government. As said by Tierney Although physician provide the huge chunks of health care
costs, they are mostly overlook of the costliness of their choice [7]. However as the
technology rapidly expanding and moving forward expanding amount of supplier providing
such program and there is concerns that might have triggered increasing variability in quality
of the system created. A simple mistake or defect of the system while assisting physician that
contribute to wrong recommendation can result in death [6]. Therefore as this issue related to
matter of life enhanced oversight and regulation is needed. Example can be seen where FDA
of US has classifies that program to health care gadgets and Legitimate obligation to those
medicine also exhortation provided for of the tolerant shall be with physician even though he
was helped by the program [5].
CDSS is relatively new in modern healthcare history even though the system had been around
industry in more than 10 years. There are still people who not accepting the technology to
assist them in getting better treatment with lower risk. The issue here is reliance and
dependence within patient and understanding where the program is not replacing physician
but more to tools that will enhance the treatment process. The system also makes the user
have a better feeling as he is better equipped to give better care therefore this should gain
patients trust and confidence.
Despite CDSS is highly advance medical technology it still have some limitation. The first
limitation is even though many of CDSS paperwork and research had been released; there is
only few which related specifically to randomized controlled trials (RCT) [7]. This means
that, only few CDSS system that had been fully compliance when tested in all environment
and condition. Therefore this shows that there is high possibility that there is system outside
in the market probably had not been fully tested and only tested in specific condition and
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environment not randomly. It must be noted there is also an argument that RCT neither give
any sign that enhanced stakeholder result or finance effectiveness which is difficult to
calculate, and not provide the scope or detail that is essential for decision making [9]. Second
limitation is most research on CDSS has studies the CDSS impacts on the health care not just
the result or charts and has zooming on physician choice. This can contribute to high risk as
physician use the system in hoping that it can assist them in making decision by giving
recommendation and show the diagnostic result, therefore the structure of the system and
how it produce the result is more important, as if the structure contain defect therefore the
recommendation and diagnostic provide to the physician will also contain defects.
Third limitation, outcome of the studies until today are blended in terms of the viabilities of
CDSS related to specific status or specific CDSS types. It is publically known that CDSS is a
high advance technology and its development is fast. Therefore many countries had
developed the system to implement in their country. The development of the system therefore
will be based on the country unique specification and there is lower chance to success if using
it in other country. Final limitation is the reminders system in CDSS which is by physician
and not nurse. It is known that many patients were seen by nurses rather than physicians, but
the actions suggested by the reminders on the CDSS system could only be taken by
physicians [10]. The nurses may not always have consulted physicians after they sighted the
reminders, therefore this resulting in no action and contribute to high risk for the patients.
CDSS develop by targeting physician as primary user with objective to reduce physician
burden in by running diagnostic and provide recommendation to cure the patients. With
burden reduce the physician is expecting to have more time in seeing the patients.
Recommendations can be proposed, first is develop exhaustive, expressive health care
vocabulary that can scan starting from control to CDSS requirement in share drive data of
health care logic and practice standard operating procedure with automatic methods which is
to update CDSS awareness data bases for taking effect current status of the literature-based
evidence. This will keep CDSS knowledge based type is up-to-date.
Second recommendation is coordinating CDSSs with others records and other related
program utilizing fitting interoperability norms. and extend the CDSS function and setting to
the outpatients as well. With growing number of outpatients in country with higher rate of age

(e.g. Japan), the outpatients setting and function is critical as this require increasingly
complex diagnostic, treatment, and supportive services.
Finally, establish CDSS implementation team which members consist of physician, nurse, IT
engineer, lawyers and law makers as public representative. This to ensure that the
implementation process is smooth and ensure the public getting an update about the program
which might help raising more public fund that can be allocate to continue the research and
improve CDSS software usefulness.

5. CONCLUSION
CDSS is an advance system that had great potential to enhanced human life, health
care standards and expanding effectiveness and decreasing the costs related to health care by
reducing time spent by physician in treating patients. CDSS implementation is a big step in
human kind. The future new generation of physician will need to be train over academic
medical training centers and different situations which include high technology IT program
and to ensure they familiar in advance technology [7], as well as patients also need to
exposed to the advance technology that going will be make public in medical industry to
avoid cultural shock and panic.
CDSS program that include proved based medical treatment give a result of
intermediate process that enhanced health care awareness. As to get benefit from this synergy,
practice-based and literature-based proved should be take into consideration programmable
knowledge bases system, fundamental and methodological base establishments.
In deciding how the implementation process should be in place, the responsibility
should rest with physician. They are the best person who should choice the way CDSS will
be applied in local health care situations. The implementation also needs to take into
consideration the advancement of the recent programs impacts on the culture, practices, and
attitudes of the kin in the association. Data about the way associated person should response
with introduction of CDSS and how it will give advantages could provide support for its
application.
Implementation team should also anticipate and be prepared to handle wide
transformations happen throughout the application procedures of CDSS. Changes in working
culture and treatment process should be expected. With this the associated person must be
able to running as usual as per timing at the same time running the application procedures IT
intermediate technology to choose the right decision. However, these may provide outcome
in wide technologies that had been accustomed in designing CDSS and subsequently invented
many basis in medical industry domain difficult to integrate with CDSS architecture.
As high end information system technology was not a bad thing or drug therefore it
must not be assessed as such. The utilization of information program through clinicians can
only happen provide that program authorize the user to give optimum care for persons who
use it. The advantages however might not be as achieve to give motivation or even give
inspiration to clinicians to changes the process they have implemented in providing
treatment.
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