Decision Support During Inpatient Care Provider Order Entry: The Vanderbilt Experience

Abstract

The need for decision support systems in medicine has been understood for 2,500 years. Hippocrates noted “Life is short, the art long, opportunity fleeting, experience treacherous, judgment difficult.” (Aphorisms, sec. I, ca. 460-400 BC).While the basis for clinical decision support has been recognized throughout the ages, careful studies in the recent medical literature document those needs specifically.1–14 Early pioneers, such as McDonald, Tierney, and their colleagues at the Regenstrief Medical Institute15–25 (see Chapter 9);Warner, Gardner and their colleagues at LDS Hospital26–28 (see Chapter 8); and many other groups have confirmed, through controlled studies, the initial report of Shakespeare in 1597: “If to do were as easy as to know what were good to do, chapels had been churches, and poor men’s cottages princes’ palaces... I can easier teach twenty what were good to be done than to be one of the twenty to follow my own teaching” (The Merchant of Venice, Act I, Scene ii). Busy clinicians have so many diverse tasks to perform that they are constantly distracted from being able to accomplish what is known to them as good medical practice. “Men are men; the best sometimes forget” (Shakespeare, Othello, 1605; Act II, Scene iii). Reminding systems and other forms of clinical decision support have been shown to be effective in overcoming such lapses of memory in a number of clinical situations.15–40 However, the success of systems intended to be used by busy practitioners is not guaranteed.