Computerized clinical decision support: a technology to implement and validate evidence based guidelines.
Faced with a documented crisis of patients not receiving appropriate care, there is a need to implement and refine evidence-based guidelines (EBGs) to ensure that patients receive the best care available. Although valuable in content, among their deficiencies, EBGs do not provide explicit methods to bring proven therapies to the bedside. Computerized information technology, now an integral part of the US healthcare system at all levels, presents clinicians with information from laboratory, imaging, physiologic monitoring systems, and many other sources. It is imperative that we clinicians use this information technology to improve medical care and efficacy of its delivery. If we do not do this, nonclinicians will use this technology to tell us how to practice medicine. Computerized clinical decision support (CCDS) offers a powerful method to use this information and implement a broad range of EBGs. CCDS is a technology that can be used to develop, implement, and refine computerized protocols for specific processes of care derived from EBGs, including complex care provided in intensive care units. We describe this technology as a desirable option for the trauma community to use information technology and maintain the trauma surgeon/intensivist's essential role in specifying and implementing best care for patients. We describe a process of logical protocol development based on standardized clinical decision making to enable EBGs. The resulting logical process is readily computerized, and, when properly implemented, provides a stable platform for systematic review and study of the process and interventions.


CONCLUSIONS
: CCDS to implement and refine EBG derived computerized protocols offers a method to decrease variability, test interventions, and validate improved quality of care.
Sucher
Joseph F
JF
Department of Surgery, The Methodist Hospital, Houston Texas, USA.
Moore
Frederick A
FA
Todd
S Rob
SR
Sailors
R Matthew
RM
McKinley
Bruce A
BA
D003658:Decision Making, Computer-Assisted; D020000:Decision Support Systems, Clinical / Q000639:trends; D019317:Evidence-Based Medicine; D005544:Forecasting; D006801:Humans; D007328:Insulin / Q000627:therapeutic use; D017410:Practice Guidelines as Topic; D012121:Respiration, Artificial / Q000592:standards; D012769:Shock / Q000628:therapy; D014194:Traumatology / Q000592:standards*
D007328:Insulin