title: Analysis of a failed clinical decision support system for management of congestive heart failure.
abstract: In order to increase compliance with The Joint Commission's Congestive Heart Failure Core Measures, a rule based clinical decision support system (CDSS) was developed and deployed at a community hospital in our health system. We evaluated the performance of the CDSS in identifying patients with primary congestive heart failure (CHF)and identified problems encountered with its introduction. Performance of the CDSS was compared against a manual review of records of patients with diagnosis of primary CHF. The CDSS had a sensitivity of 0.79 and PPV of 0.11. The CDSS issued multiple alerts for majority of the patients(74%). The number of alerts issued for patients without primary CHF was large, and for a majority of patients (63%) physicians did not respond to alerts the first time. The CDSS performed poorly and was eventually withdrawn but provided insight into a subsequently successful method for managing CHF.
authors.affiliation: Department of Biomedical Informatics, University of Pittsburgh, Pittsburgh, USA.
authors.forename: Rajiv
authors.initials: R
authors.lastname: Wadhwa
authors.forename: Douglas B
authors.initials: DB
authors.lastname: Fridsma
authors.forename: Melissa I
authors.initials: MI
authors.lastname: Saul
authors.forename: Louis E
authors.initials: LE
authors.lastname: Penrod
authors.forename: Shyam
authors.initials: S
authors.lastname: Visweswaran
authors.forename: Gregory F
authors.initials: GF
authors.lastname: Cooper
authors.forename: Wendy
authors.initials: W
authors.lastname: Chapman
mesh_terms: D003658:Decision Making, Computer-Assisted; D003936:Diagnosis, Computer-Assisted / Q000379:methods*; D003951:Diagnostic Errors; D006333:Heart Failure / Q000175:diagnosis*; D010414:Pennsylvania; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity