In recent years, we have witnessed a rise in the use of informatics within healthcare settings. The development of applications such as clinical decision support (CDS) systems ensure that clinicians and allied health personnel are armed with the knowledge acquired and curated by the health sciences community. The impact of these applications in practice are directly measured by the foundational informatics methods and tools employed within the applications. In this issue of JAMIA, we present articles focused on clinical informatics and interventions that directly affect patient care.
The use of CDS systems in healthcare is becoming more prominent; hence the importance of CDS systems’ design, functionality, and accuracy. Miller (p. 585) reviews functional requirements and design of CDS systems. A systematic review by Varghese (p. 593) analyzes the recent literature on CDS systems with regards to patient outcomes in the inpatient setting, while Austrian (p. 523) shows the impact of a CDS system that monitors sepsis and related mortality and length of stay in emergency care. Relevant to the current opioid crisis, an article by Finley (p. 515) reports on the feasibility of a decision support system for prescription monitoring in a military healthcare setting. Dagliati (p. 538) presents a dashboard system to support diabetes care, while Li (p. 548) and Hodge (p. 603) study electronic problem lists. Horsky (p. 465) shows how improved design will result in higher accuracy for complex medication reconciliation processes.
Effective CDS systems also rely on updated knowledge bases. Lacson (p. 507) discusses the curation and contents of evidence libraries, and Van Allen (p. 458) contrasts interactive and static reports for cancer genomics. Tamblyn (p. 482) describes how patient safety can be improved with a computer-assisted tool for medication reconciliation that integrates population-based community data. Brown (p. 568) uses machine learning techniques for automated neuro-MRI protocol selection, and Wu (p. 530) describes a general-purpose system to extract data from clinical notes.
As the name implies, decision support systems assist clinicians in making decisions, but sometimes automated systems fail to consider important contextual information or simply make mistakes of their own. Nanji (p. 476) describes the characteristics of medication-related CDS overrides. Wright (p. 496) analyzes CDS system malfunctions, and Stone (p. 564) presents two cases of unintended adverse consequences of a CDS system. Tolley (p. 575) reviews the factors that contribute to medication errors when clinicians use computerized order entry in pediatrics, and Ni (p. 555) describes a system for real-time medication administration error detection in a neonatal ICU. Finally, there is a lot of discussion in our community on the costs and benefits of EHRs. Wright (p. 572) shows that the transition to a new electronic health record system does not affect hospital bond ratings.
JAMIA has been featuring the best work in clinical informatics since its inception. Much has changed in the past two-and-a-half decades, and the spectrum of topics we publish has expanded to reflect the expansion of biomedical informatics. As always, we continue to select the most original work and to value both foundations and applications of informatics that lead to better patient care, disease prevention, and scientific discoveries.