# Aligning EMR Structure with Treatment Cycles: Enhancing Data Management and CDSS Functionality
## 2 Related Works
### Literature Review on Cyclical Approaches in Medical Information Systems  
CDSS have become central in enhancing clinical workflows by providing timely recommendations that integrate patient data with evidence-based guidelines. Several studies indicate that embedding iterative feedback loops into CDSS design can significantly improve performance. For instance, cyclic frameworks such as the Plan-Do-Study-Act (PDSA) system have been applied to continuously refine CDSS outputs, ensuring that the system adapts to evolving clinical needs and minimizes errors in real time [20]. The iterative nature of such cycles allows developers to test changes on a small scale, study the outcomes, and then act by modifying the system. On the other hand, the diagnostic process in clinical settings is intrinsically iterative. Diagnostic workflows often require repeated data collection cycles, hypothesis testing, and reinterpretation as new patient information becomes available. Studies in the field have demonstrated that the cyclical approach (in which clinicians and systems repeatedly \"loop\" through stages of assessment and re-evaluation) can significantly enhance the diagnostic accuracy [21]. [PERSON] et al. [22] emphasized that continuous learning processes in medical systems are essential in ensuring both clinical safety and cost-effectiveness. In this view, the cyclical approach is fundamental because it allows systems to respond dynamically to the complexities of real-world healthcare. Similarly, [PERSON] [23] found that incorporating iterative diagnostic cycles into CDSS improved the timeliness and accuracy of diagnoses, highlighting the inadequacy of a single, static implementation when patient data change rapidly.  
Beyond diagnosis, cyclical approaches have proven valuable in outcome evaluation and cost management. [PERSON] et al. [24] pointed out the limitations of static assessments, arguing that they fail to capture the ongoing benefits of system refinements over time. They recommended conducting repeated outcome assessments to accurately reflect the evolving nature of clinical practice and technological performance within the CDSS environment. [PERSON] et al. [25] claimed that iterative cost recalibration enables more accurate resource utilization tracking. This guarantees that financial evaluations remain reflective of real-world operational conditions.  
Furthermore, [PERSON] and [PERSON] [26] demonstrated in their study that continuous monitoring provides essential feedback for effective care coordination across the diagnostic process. This aligns with the \"continuum of care\" concept, emphasizing seamless and integrated healthcare delivery across different stages and settings. This cyclical model supports continuous learning and the refinement of diagnostic processes by providing clinicians with consistent feedback on their diagnostic reasoning and outcomes [27]. Theiterative nature of diagnostic processes, as described in the context of diagnostic paths, underscores the importance of cyclical approaches. By continuously gathering and integrating information, clinicians can refine their working diagnoses and improve the diagnostic accuracy over time [28; 29].