A medical paper clarifying the effectiveness of a clinical decision support system that automatically supports medical treatment based on clinical guidelines has been published in the international academic journal "Scientific Reports"

A paper by Professor Tsuyoshi Morimoto of Clinical Epidemiology and graduate student Nobuyuki Morikawa of Clinical Research has been published in the international academic journal Scientific Reports (September 2, 2022).

A prospective cohort study was conducted on all patients attending outpatient departments at a general hospital, and it was revealed that introducing a clinical decision support system into electronic medical records led to more effective treatment based on clinical guidelines. For more details, please see below.

Effectiveness of a computerized clinical decision support system for prevention of glucocorticoid-induced osteoporosis

Nobuo Morikawa, Miori Sakuma, Tsugu Nakamura, Tomohiro Sonoyama, Chisa Matsumoto, Jiro Takeuchi, Yoshinori Ota, Shinji Kosaka, and Tsuyoshi Morimoto

The clinical decision support system tested in this study refers to a system that supports clinicians by automatically displaying recommended medical treatments in line with clinical guidelines as alerts or ordering screens in electronic medical records according to the condition of each individual patient.

In this study, we developed a clinical decision support system that implemented the glucocorticoid-induced osteoporosis guidelines, and conducted a prospective cohort study to analyze "changes in the clinical treatment process based on the glucocorticoid-induced osteoporosis guidelines before and after the system's implementation."

The results of this study suggest that the introduction of a clinical decision support system can improve practice in accordance with clinical practice guidelines.

Clinical practice guidelines play a central role in improving and standardizing the quality of medical care, but it has been reported that in actual clinical practice, the rate at which clinicians adhere to clinical practice guidelines is insufficient. Evaluating whether it is possible to increase the rate of adherence to clinical practice guidelines in daily practice is an important clinical issue.

The research group focused on steroids, a drug administered to treat a variety of diseases. Steroids are administered to many patients and are dramatically effective, but steroid-induced osteoporosis, a side effect of steroids, is also a clinically important issue. Clinical practice guidelines for steroid-induced osteoporosis have been published in Japan, but compliance rates are low. Furthermore, research examining the impact of clinical decision support systems on compliance rates with clinical practice guidelines is rare internationally. This research group developed a clinical decision support system based on clinical practice guidelines for the prevention of steroid-induced osteoporosis, implemented it in electronic medical records, and verified its effectiveness, a world first.

A prospective cohort study was conducted on outpatients who received steroids for more than three months and met the indications for treatment based on clinical practice guidelines for the prevention of steroid-induced osteoporosis.

We introduced a clinical decision support system that automatically recommends bone mineral density testing and bisphosphonate prescriptions based on clinical guidelines in electronic medical records.A total of 938 patients (457 before implementation, 481 after implementation) were analyzed over the one year before and one year after implementation.
Among patients who received alerts recommending bone mineral density testing, the number of patients who underwent bone mineral density testing increased significantly, from 4% before implementation to 24% after implementation. As a result, the number of patients receiving bone mineral density testing alerts decreased significantly, from 93% before implementation to 87% after implementation. Meanwhile, among patients receiving bisphosphonate prescription alerts, the number of patients who were actually prescribed bisphosphonates increased from 16% before implementation to 19% after implementation, and the number of patients receiving bisphosphonate prescription alerts increased from 67% before implementation to 63% after implementation, demonstrating numerical improvements, but the differences were not significant.
In addition, when comparing the alert acceptance rates by medical department, it was found that general medicine departments tended to have significantly higher alert acceptance rates for both bone density tests and bisphosphonate prescriptions compared to other medical departments.

・Grant-in-aid for Scientific Research (18H03032, 21H03176): Tsuyoshi Morimoto
・Health, Labor and Welfare Research Grant (H26-Iryo-012, H28-ICT-004): Tsuyoshi Morimoto

These results suggest that the introduction of a clinical decision support system may enable the implementation of high-quality medical care in accordance with clinical guidelines. However, even with the introduction of a clinical decision support system, it is possible that the bisphosphonate prescription rate and bone mineral density test implementation rate may not have reached ideal levels. Further analysis is needed to determine the factors behind the low alert acceptance rate and differences between medical departments, and outcome evaluations such as fractures are also necessary.