# Aligning EMR Structure with Treatment Cycles: Enhancing Data Management and CDSS Functionality
## 1 Introduction  
The inherent complexity of medical settings has highlighted the importance of system design concerns. This sensitivity increases exponentially when medical decisions are made using data processed by clinical decision support systems (CDSS) [1]. This complexity has increased due to the growing volume and diversity of patient data, necessitating advanced tools like CDSS to manage and support decision-making in these complicated clinical environments [2]. Recent studies highlight the critical role of CDSS in improving clinical practice across diverse fields such as nursing, pediatrics, and oncology, emphasizing their practical usability and widespread applicability in addressing complex healthcare challenges globally [3]. The successful implementation of CDSS depends on their seamless integration into healthcare providers' existing workflows and decision-making processes [4, 5]. Usability experts have emphasized that effective system design significantly enhances usability and ensures physician adoption of CDSS [6]. Unlike interface design, which concentrates on a system's visual and interactive aspects, system design encompasses the structural, functional, and operational frameworks of CDSS. It addresses how data isorganized, retrieved, and presented to users, ensuring that the system is compatible with medical professionals' real-world needs and workflows [7; 8]. Poor system design hinders the fulfillment of physicians' needs and may lead to overwhelm and dissatisfaction. It ultimately can negatively impact patient care [9]. One significant deficiency in the prevalent system design is incompatibility with current medical processes [10]. Among the deficiencies mentioned, the cyclical nature of the treatment plan can be firmly perceived as the prominent requirement. A treatment cycle often contains a sequence of distinct chain phases (diagnosis, treatment plan, and result evaluation), and the existing system designs within medical information systems still do not address the cyclical nature of these phases [11]. Electronic medical records (EMRs), as the principal platforms for medical data collection, are no exception to this. Since they are considered data providers for CDSS, this compatibility with real-world needs must be observed for EMR system design [12]. In contemporary system design, medical data are frequently presented in isolated fragments, which reduces physicians' ability to comprehensively comprehend the patient's medical history and current treatment needs. In other words, the treatment cycle to which the registered data belong is not explicit. This ambiguity reduces the necessary transparency for data analysis [13]. This problematic situation highlights a critical research gap: how can CDSS be designed to align with the inherent cyclical nature of treatment plans? Existing system designs often prioritize medical data entry and retrieval within EMRs, regardless of how data categorization and labeling affect the next-step data analysis and medical decision accuracy [14; 15]. To the best of our knowledge, no prior research has explicitly investigated the impact of a cyclical treatment approach on the design of CDSS that integrate with EMR data. Addressing this gap is essential for several reasons. First, enhanced clinical decision-making hinges on our ability to understand and incorporate the cyclical nature of treatment plans into CDSS design. Second, concentrating on cyclical data tagging and organization within EMRs streamlines data retrieval and analysis, elevating the quality of patient care. Finally, this study aims to fill the gap in the existing studies regarding the relationship between the cyclical nature of treatment plans and CDSS design, establishing a foundation for future research and innovation in this critical area. To address this gap, the current study proposes a cycle-oriented approach to CDSS design, investigating different aspects of this approach. In this regard, the upcoming sections are defined as follows.