Date post: | 14-Aug-2015 |
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Clinical Decision Support SystemsChapter 20
Objectives
What are three requirements for an excellent decision making
systems?
What are three decision support roles for computers in clinical
medicine?
What are five dimensions that characterized clinical decision support
tools?
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Clinical Decision Making
Medical Practice is medical decision making
Computer can have a direct or tangential effect on the quality of decisions
Clinical decision making is the process by which it determine who needs what and when
Three requirements for decision making
Accurate data
Pertinent knowledge
Appropriate problem solving skills
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Clinical Decision Making
A major challenge occurs when decision makers are bombarded with so
much information that they cannot process rapidly.
Decision makers must have broad knowledge of medicine and in depth
familiarity with their area of expertise
Their knowledge must also be current4
The Role of Computers in Decision Support
A clinical decision support system is any computer program designed to
help healthcare professionals to make clinical decisions
1. Tools for Information Management
• Specialized knowledge management workstations are under development in
research settings
• These workstations provide sophisticated environments for storing and
retrieving clinical knowledge5
The Role of Computers in Decision Support
2. Tools for focusing attention
• Clinical laboratory systems that flag abnormal values
• Provides lists of possible explanations for those abnormalities
• Program are designed to remind the user of diagnosis6
The Role of Computers in Decision Support
3. Tools for providing patient specific recommendation
• Provides custom tailored assessments
• Advice based on sets of patient specific data
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Historical Perspective
1. Leeds Abdominal Pain System (1972)
• University of Leeds studied the diagnostic process and developed
computer based decision aids using Bayesian Probability theory
• Leeds abdominal pain system used sensitivity, specificity and disease
prevalence data for various signs, symptoms and test results
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Historical Perspective
1. Leeds Abdominal Pain System (1972)
• The probability of seven possible explanations for acute
abdominal pain are
Appendicitis, Diverticulitis, Perforated Ulcer, Cholecystitis, Small
bowel obstruction, Pancreatitis and non specific abdominal pain.9
Historical Perspective
2. MYCIN (1976)
• MYCIN program a consultation system that de emphasized diagnosis to
concentrate on appropriate management of patients who have infections.
• MYCIN was represented as production rules each containing a “Packet” of
knowledge derived from discussions with collaborator experts.
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Historical Perspective
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Example
Historical Perspective
3. HELP (1979)
• An integrated hospital information system developed at LDS Hospital in Salt Lake City
• HELP has the ability to generate alerts when abnormalities in the patient record are
noted
• HELP adds to a conventional medical record system a monitoring program and a
mechanism for storing decision logic in “HELP” sectors or Medical Logic Module (MLM)
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A structure for Characterizing Clinical Decision Support Systems
Five dimensions of characterized clinical decision support systems
1. The systems Function-What is true about a patient and What to do for the patient
2. The mode by which advice is offered-The decision support system waits for the user to come to it
3. The consultation style-The program serves as an advisor or ideas
4. Underlying decision making process-Specific flowcharts designed by clinicians
5. Factors related to human computer interaction-User’s professional routine use of computer
system
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Barriers to Decision Support Tools
Acquisition and Validation of Patient Data
Modeling of Medical Knowledge
Elicitation of Medical Knowledge
Representation of and Reasoning about Medical Knowledge
Validation of System Performance
Integration of Decision-Support Tools14
Examples
The Internist-1/ QMR project
Diagnostic program developed at the University of Pittsburg School of Medicine
Program known as Quick Medical Reference (QMR)
Contained knowledge of almost 600 diseases and of nearly 4,500 interrelated findings or disease
manifestations
On average each disease was associated with between 75 and 100 findings
The Dxplain System
Produced a ranked list of diagnoses that might explain the clinical manifestations.15
Patient Management: Guideline Based Architectures
Clinical practice guidelines standardize and provide uniform improvement in
the quality of medical care.
Guideline-Based Patient-Management Systems
Situation based rules
Skeletal plans
Protocols
Example: EON system
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EON System
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Legal and Regulatory Issues
Negligence Law
Strict liability
Validation of tools prior to release
Role of government in regulation
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