Analysis of a failed clinical decision support system for management of congestive heart failure

Wadhwa, R, Fridsma, DB, Saul, MI, Penrod, LE, Visweswaran, S, Cooper, GF, Chapman, W. Analysis of a failed clinical decision support system for management of congestive heart failure. In: Proceedings of the Fall Symposium of the American Medical Informatics Association (Nov 2008) 773-7. PMID: 18999183 PMCID: PMC2655961

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 The CDSS performed poorly and was eventually withdrawn but provided insight into a subsequently successful method for managing CHF.

Publication Year: 
2008
Publication Credits: 
Rajiv Wadhwa MD, Douglas B. Fridsma MD PhD, Melissa I. Saul MS, Louis E. Penrod MD, Shyam Visweswaran MD PhD, Gregory F. Cooper MD PhD, Wendy Chapman PhD
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