Decisions, Decisions – Libraries, Bandwagons and Clinical Decision Support Systems

In recent years, many health libraries have bought bundles of electronic resources, as a way of providing online access to clinical information throughout their health service. Such collections may include citation databases, drug resources, fulltext journals and textbooks.

With networked access to these products often available throughout a health service, clinicians are encouraged to integrate quick searches into their process of deciding a patient’s care. Projects in clinical librarianship are also fostering active use of electronic resources to resolve uncertainties in patient care. The clinical librarian researches questions of specific patient care and prepares a summary of findings for the medical team, often within a 24-hour time frame.

Computerised clinical decision support systems (CDSS) are also becoming mainstream applications in many health services. These programs are designed to flag an individual medical record when the patient passes a critical boundary, such as falling due for a routine test, or registering a raised blood pressure reading. The treating physician is prompted to initiate preventive or early interventions to avert a likely problem, or alerted when incompatible drugs or unsuitable tests are ordered.

The attraction of a CDSS is that – if followed – it saves treatment dollars and may improve patient health. There are suggestions that serving up online information resources will give some of the same benefits. As more knowledge emerges about the impact of library resources on patient care, recent systematic reviews of decision support systems are highlighting the features which are key to their effectiveness. In this paper, we examine the evidence for the relative value of electronically delivered library resources and truly integrated decision support systems, and make a case for a broader definition of the value library resources and services add to clinical care.