Issues of trust and ethics in computerized clinical decision support systems.

Clinical decision support systems are computer technologies that model and provide support for human decision-making processes. Decision support mechanisms facilitate and enhance a clinician's ability to make decisions at the point of care. Decisions are facilitated through technology by using automated mechanisms that provide alerts or messages to clinicians about a potential patient problem. A clinician's level of trust in these technologies to support decision making is affected by how knowledge is represented in these tools, their ability to make reasonable decisions, and how they are designed. Furthermore, ethical tensions occur if these systems do not promote standards, if clinicians do not understand how to use these systems, and when professional relationships are affected. Issues of trust and ethical concerns will be examined in this article, using a research study of midwestern nursing homes that implemented a clinical decision support system.