Medical Decision Support System
Introduction
Today’s generation has provided different fields of study a number of advancements and developments that not only entail making work and jobs easier, but making it faster and more accurate. The discovery and invention of many different applications of technology and science in different fields have provided many individuals with significant and relevant benefits, which helped each field flourish and become very helpful to any individual in the society. This is specifically observable in the field of medicine, which is particularly significant in the diagnosis and treatment of different diseases.
The relevance of technology to medicine has already been evident, through the application of computers and advanced technological equipments used in the diagnosis and treatment of certain diseases, such as cancer and heart diseases. Its application has also been observed in most especially in medical, healthcare, and genetic researchers, which pose great discoveries and breakthroughs that would benefit each and everyone in the society. In this regard, technological decision support systems, such as computer systems are relevant and significant breakthroughs in the field of medicine. Decision support systems, such as computer systems are regarded to speed up medical and patient care decision making that would benefit medical clients needing medical and healthcare services.
Problem Statement
What impacts do these computer systems have on medical decision making and patient care, and who bears responsibility for (mal) functioning of the system?
Objectives of the Paper: Reasons for Interest
This paper aims to help increase knowledge and information regarding computer decision support systems and its effects in the medical and healthcare field. The specific reasons for interests or objectives of this paper can be summarized as follows:
1) To know what clinical or medical decision support systems are;
2) To determine the effects of using medical decision support systems;
3) To find out what ethical issues and codes are involved in the use of medical decision support systems;
4) To determine the different legal issues involved;
5) To cite specific examples or situations of its use; and
6) To deduce relevant conclusions and recommendations
General Background
To be able to further understand and make relevant conclusions on the ethical and legal issues regarding medical decision support systems, it would be important to shed light on what is a medical or clinical decision support system, including its uses, benefits, and relevance in the medical and healthcare field. Such concepts and understandings are important to take note of, as these would enable one to draw ethical and legal delimitations of the use of medical or clinical decision support systems.
It has been reported that the concept of computer-based diagnostic and other decision support systems for patients or clients are difficult to separate from the more general area of consumer health informatics. Consumer health informatics represents a diverse field devoted to the development, implementation, and research on telecommunications and computer applications designed to be used by consumers to access information on a wide variety of healthcare topics. This technology, both hardware and software, is part of a growing trend toward empowering consumers to take a more active role in their own healthcare and to provided the necessary information to enhance their decision making. Today, more than ever, consumers are using information technology either as a substitute for traditional physician-based medical information or as a supplement to the information provided by healthcare professionals in the course of clinical encounters ( 1999). Likewise, such importance can also be determined and pinpointed in the perspective of medical or clinical health professionals, who regard computer-based systems as essential and beneficial in their practice. Computer-based systems are beneficial in terms of generating alerts and reminders for clinical or medical healthcare professionals, most especially in terms of a busy schedule and large amounts of load. It provides diagnostic assistance, as the use of computer-generated findings and examinations would essentially provide better diagnosis and treatment to clients. The use of computer-based support systems would also provide therapy critiquing and planning, which would allow medical or clinical healthcare professionals with the opportunity to continually critique appraise and improve their planning strategies. Such computer-based support systems also enable image recognition and interpretation, which not only assist medical or clinical healthcare professionals in the diagnosis but also in the treatment of diseases. The number of its uses makes one to become overwhelmed by the operation of the computer-based support system. In this regard, it is essential to know what a medical or clinical decision support system is.
A medical or clinical decision support system or CDSS is defined as software that integrates information on the characteristics of individual patients or clients with a computerized knowledge base for generating client-specific assessments or recommendations designed to aid clinicians and/or patients in making clinical decisions. Work on such systems has been under way for decades with minimal impact on healthcare delivery. Interest in clinical decision support systems has grown dramatically during the last decade. However, in part because of the promise such systems hold for assisting clinicians and patients in applying science to practice ( 2001). This definition excludes electronic textbooks, hypertext and text databases, as these require the user to formulate and conduct the search and do not attempt to synthesize search results into a report which applies specifically to a particular client. It also excludes computer-based teaching and learning tools, which are designed to enhance a clinician’s knowledge, not assist them with specific client management decisions. It is possible to gain access to some decision support system using the Internet or the World Wide Web. However, most Internet sources, being passive do not qualify as decision support systems. Finally, because they do not contain medical knowledge or give advice, computer systems, which acquire, process or communicate client data, clinical data systems are also excluded, though appropriately organized data can improve medical decisions (. 1997).
In addition, decision support systems or also called decision aids, consist of a store of medical knowledge, or knowledge base, and a reasoner a computer program, which uses two or more clinical findings to select, display, or apply relevant facts from this knowledge store. To obtain advice or information from a clinical decision support system, it must be provided with client data such as the age, clinical findings, diagnosis, current medication, test results, and the like. Such data may be entered by the clinician or obtained from a clinical data system, directly or via a network connection (. 1997). The applications of clinical decision support systems assist clinicians and patients with three types of clinical decisions, namely, preventive and monitoring tasks, prescribing of drugs, and diagnosis and management ( 2001).
Applications of Clinical Decision Support Systems: Examples
Contributors to the body of knowledge of applying computer systems to clinical practice include the several sites where hospital-based, medical decision support have been implemented and studied. Among the leaders in these efforts have been groups at the Regenstrief Institute in Indianapolis, Columbia Presbyterian Medical Center in New York, and Beth Israel Hospital in Boston. Examples of applications include decision support tools that critique medication orders and the system for identifying life-threatening laboratory results, which are described using the HELP system used and developed by the members of the Department of Medical Informatics of the University of Utah ( 1999).
Another significant application of medical or clinical decision support system is evident in pediatrics. Clinical decision support systems in pediatrics were focused on diagnostic recommendations. Pediatric decision-support can be provided by any computer system that deals with clinical data and medical knowledge to help deliver client-specific advice. Laboratory systems that flag abnormal values, immunization registries that issue vaccination reminders, and automated pediatric electrocardiograph or ECG interpretation are just a few examples of the use of system in common use today. In addition, the development of a pediatric anti-infective decision-support system program that was integrated into the hospital information system in Utah is one specific application of the use of the medical or clinical decision support system. It has been emphasized that the use of the tool in a pediatric intensive care unit or PICU was considered beneficial to patient care by the clinicians, reduced the rates of erroneous drug orders, improved therapeutic dosage targets, and was associated with decreased costs per client ( 2005). Moreover, a specific study emphasizes the significant and relevant application of medical or clinical decision support systems in the hospital setting. This specific study indicates that through the CDSS, a large medical database of over 2000 intensive care patients containing 98 fields of clinical and administrative information on patients admitted to the ICU was collected and inputted, with some retrospective chart review. In the used system, up to seven medical diagnoses and multiple procedures can be recorded, with auxiliary space for free-form comments. Significant events in the ICU course of the client and complications that occur can also be placed and noted in the system ( . 1997).
Impacts on Medical Decision Making: Ethical and Legal Issues
From previous discussions, it can be perceived that the use and applications of medical or clinical decision support systems prove to be beneficial and advantageous in the hospital setting and in the medical field. This is because the use of such systems focuses on the efficiency and efficacy of providing accurate diagnosis and treatment to different diseases and ailments of many patients or clients. It also assists medical or clinical healthcare professionals in targeting accuracy in terms of detecting causes of diseases, which may not be initially diagnosed. It provides medical and clinical healthcare professionals with less time finding clinical records, thus, having more time to make rounds and see the condition of their patients or clients. The use of such a system also gives opportunity to medical professionals and clients alike to gain knowledge through access to the system, thus, further understanding medical conditions. Lastly and most importantly, guidelines and information are computerized, thus, organized and retrieval of information is easier. In this sense, the system can greatly assist with the diffusion of guidelines and information into practice ( 1999). However, despite such positive effects and advantages, still, a number of negative impacts can be pinpointed, which can be perceived as both ethical and legal issues related to the use of the system. Such ethical and legal issues raise questions on the effects the use of the system would have on the decision-making of both medical professionals and clients, and on the malfunction of certain systems.
Ethical Issues – Ethics in the medical practice is defined as the science or study of morals, and refers to how individuals determine what is good for the flourishing of people in society, and what rules individuals need to prevent people from being harmed (. 2000). Using this definition, ethical issues in both client and medical professional perspective would be emphasized. Primarily, an ethical issue that is related to the welfare of clients is the issue on empowerment and self-efficacy. Empowerment can be thought of as the process that enables people to “own” their lives and have control over their destiny, and is closely related to health outcomes in that powerlessness has been shown to be a broad-based risk factor for disease. On the other hand, self-efficacy is a patient’s level of confidence that he or she can perform a specific task or health behavior in the future. Several clinical studies have shown self-efficacy to be the variable most predictive of improvements in patients’ functional status ( 1999). In this regard, letting recovering patients or clients to use such a system may offer either a positive or negative feedback from the client, as he or she may feel either neglected or perceived as independent by the medical practitioner. Although autonomy is given to provide independence to the client, it would still be ethical and morally right to assist the client as long as he or she is confined in the premises of the medical institution.
Another ethical consideration is the issue on the privacy and confidentiality of the information provided by the client. It has been reported that more than half of the hospitals in the United States are implementing electronic patient record systems. The National Research Council has estimated that the healthcare industry spends as much as billion annually on information technology, an amount that is expected to grow by 20% per year. The importance of collecting, electronically storing, and using health information is undisputed. However, the problem is systemic and arising out of the routine use and flow of information throughout the health industry. Healthcare information is primarily transferred among authorized users, wherein the information is not only used for patient care and financial reimbursement, but also for medical, nursing, and allied health education, for research, social services, public health, regulation, and litigation, and for commercial purposes such as the development of new medical technology and marketing ( and 2002). In this regard, the privacy and confidentiality of the information provided for by a client is not entirely kept in the system. This must not be so, as any information provided for a human being has an intrinsic value that should regulate a moral action affecting it ( 2006). Thus, confidentiality and privacy serves to be threatened with the use of such a system. In relation to confidentiality and privacy issues is data dredging and data fishing. Data dredging occurs when a database is subject to analysis that was not part of the original clinical trial protocol, which data fishing is action that seeks to obtain a result if the analysts try long and hard enough. Both processes allow greater use of existing data, which are improper and unprofessional ( 2002). Such processes are ethical issues to consider as use of private information are being done without the consent of the concerned individuals. Lastly, the decision-making process of medical practitioners is also considered one of the ethical issues. Some medical or healthcare professionals might have the perception that such systems were designed and implemented as autonomous systems that replace human judgment, thus, making their jobs easier. In this regard, the right of a client or patient to obtain the best form of treatment or service is being compensated.
Legal Issues – Computers and software raises conceptually fascinating and important practical questions about responsibility and liability. Further, the question whether a decision support system is a medical device needing governmental regulation is a source of tension and debate. In both domains, scientists, clinicians, philosophers, lawyers and government and policy officials must grapple with a variety of knotty problems. The intersection of medicine, computational decision support and law has been addressed mostly in speculative terms. The use of decision support systems is not widespread enough to have stimulated legislation or illuminating precedent. Moreover, medicine and computing share little in the way of a common legal history, thus, the legal differences between them are striking. Medicine is tightly regulated at all levels, wherein most healthcare providers are licensed, and a rigid hierarchical system is the norm. Yet, computer systems and companies are created in a totally unregulated competitive environment in which “software piracy” is common, standardization is in its infancy, licensing is a method of transferring trade secret software, and companies begin in garages ( 1999). In this regard, it can be perceived that because the field of medicine and the field of computers may be far ahead from each other, it would be difficult to apply legal matters that would combine both fields. However, in the issue of the use of medical or clinical decision support systems, legal issues that combine both fields would be relevant. Primarily, the overriding legal issue related to computational decision support is liability for use, misuse or even lack of use of a computer to make or assist in rendering diagnoses ( 1999). It has been emphasized that the use of the system may increase a physician’s consultation time, thus decreasing the time spent on direct patient care. However, although the use of the system may improve efficiency in terms of data recall, an erroneous system provides erroneous information and guidance, which has the potential to cause broad deleterious impacts ( 2001). In this sense, the legal issue that must be taken note of is the misuse of the system, which may breed opportunist medical practitioners that are only in for the additional consultation fee and not for providing effective and efficient services to clients. In addition, overpricing may also be one legal issue, as medical practitioner may place additional charges on their services. The development and frequent updating of system software is also likely to be very expensive ( 2001), thus, some medical practitioners may generate an idea of charging extra fees for their own benefit. Because of this, in the United States, tort law holds providers of goods and services accountable for injuries sustained by users. Such accountability is addressed by either the negligence standard or the strict liability standard set by hospital authorities. The negligence standard applies to services, and strict liability applies to goods or products ( 1999).
Conclusion and Recommendation
From the discussion, it can be deduced that the use of the medical or clinical decision support system would be significantly beneficial and advantageous on the part of both the medical practitioner and the client. As mentioned earlier, such systems focus on the accuracy and efficacy on providing diagnosis and treatment of patients, which is the goal of the field of medicine firsthand. However, the different ethical and legal issues presented in previous discussions may somehow hinder the perceived benefits of the use of such systems.
In this regard, several recommendations can be provided, such as providing additional education and information regarding the use and misuse of computer-generated systems in order to maximize its potential. Another recommendation is for medical practitioners to become well informed regarding the needs of their clients, regardless of socio-economic status. Lastly, it would also be helpful if privacy and confidentiality issues would be addressed through laws that would protect the information provided by clients.
References
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