Search

 This Document

 All Library Documents



 Other Documents
Page tree

Versions Compared

Key

  • This line was added.
  • This line was removed.
  • Formatting was changed.

Toc hidden headings

Overview

The purpose of the communications mechanism is to handle CDS communications into and out of the system. Examples of user inputs include entry of clinical data, and the selection of a proposed drug, order set, or treatment regime. Examples of outputs include CDS interventions such as alerts, guidelines, diagnostic refinements, and smart forms. These outputs are typically delivered to the user u ser interface. SNOMED CT has limited involvement in the communications mechanism of CDS as most of the codes and features will be used by the knowledge base and inference engine. That being said, it is possible that SNOMED CT terms are used at the user interface level as part of the data entry process. For more information on using SNOMED CT to support data entry, please refer to the  Search and Data Entry Guide. SNOMED CT can also be used in the CDSS outputs. For example, using the relevant terms in the alert messages, populating smart forms with SNOMED CT codes, or linking terms in CDS guidelines to other appropriate clinical knowledge sources.

The figure below depicts the key interactions of the CDS communications mechanism.

Caption figure
Communications key interactions

Once the inference engine has determined that an intervention is appropriate, the communications mechanism takes over and handles its delivery. Conversely, user inputs are also delivered into the CDSS by the communications mechanism. Note that guidelines or knowledge resources may reference externally hosted content, which may be accessed by the user via a link. An example of this would be a PubMed

Footnote Macro

https://www.ncbi.nlm.nih.gov/pubmed/

citation for biomedical literature.

Note that the diagram also shows how the internal CDSS communications (associated with the external inputs and outputs) are related to the components of the CDS rule. The communication 'inputs' feed into the event (from "ON event") and the condition (from "IF condition") components of the rules, while the 'outputs' are the result of the action (from "THEN action") that is performed if the event occurs and condition is true.

Example

The following screenshot

Footnote Macro

Screenshot provided by Practice Fusion.

was generated from an EHR with CDS capabilities. This illustrates what a typical CDS intervention may look like.


scroll-pdf

...

-ignore

Image Modified


Hide in Web View

Image Modified


Caption figure
User Interface depicting CDS intervention which links to knowledge resource

Note that the contents of this alert have been magnified for the purpose of this illustration. Characteristics of this alert include:

  • It appears at the top of the screen using fonts and colors that help to distinguish it from other content. (Alerts, by design, are intended to be noticed.)
  • It includes mechanisms to process the intervention as appropriate (e.g. to acknowledge, accept or discard the alert). In this case, the alert my be closed (by clicking the X) or the suggestion to order a lab test may be accepted (by clicking on "order a lab").
  • It provides a link to applicable reference information (as illustrated above by the PubMed


    Footnote Macro

    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3534745/

    screenshot.)

  • It includes an option to "minimize notifications". This option allows the user to minimize the number of alerts displayed, by selecting the types of alerts they wish to receive in their user preferences.

Alert Fatigue

Alert fatigue

Footnote Macro

Uses content from: https://psnet.ahrq.gov/primers/primer/28/alert-fatigue

is an unwanted side effect of CDS. Alert fatigue occurs when clinicians become overwhelmed by or desensitized to CDS alerts because of their sheer number, intrusive nature, or non-relevance to a clinical situation. The danger of alert fatigue is that the clinician will miss something important as a result. Strategies are required to minimize alert fatigue. Some of the interesting ideas proposed by thought leaders in CDS include:

...