Clinical decision support (CDS) systems in eye and vision care

Clinical decision support (CDS) systems are information technology systems designed to improve clinical decision making. From the health care perspective, CDS refers to a variety of approaches providing clinicians, staff, patients, and others with knowledge and individualized person-specific information. CDS assists clinicians at the point of individual patient care and has important applications for improving population health. Evidence from a systematic review was categorized into four modeled functional areas: administrative, clinical complexity management, cost control, and decision support. The evidence was extracted from peer-reviewed journals, published abstracts, conference presentations, and professional meetings proceedings. Thirty-nine articles met inclusion criteria; the majority were related to diabetes population and telemedicine-related applications. New theoretical methods for estimating treatment thresholds and emerging population risk factors were identified that will ultimately affect physician risk thresholds in managing chronic conditions. Existing strategies/tools for future use include: applications for encoding/exchange of metadata; grading algorithms and other disease/condition-specific differential diagnostic tools; access to eye care-specific evidence via Electronic Health Record (EHR) systems; eye disease and vision condition-specific decision trees and cost-effectiveness models; use of graphical information systems (GIS) for population compliance management; and stakeholder tele-support. These represent a small fraction of CDS applications that can assist in meeting the unique needs of eye care providers and patient populations. Despite the widespread use of CDS systems throughout health care and the increased applications in eye and vision care over the past decade, there remains a limited scope of applications in eye care.