Evolution: Early Systems. DX plain – CDSS – Diagnosis aid 1989 HELP – HIS integrated with CDSS 1980 Current Systems MYCIN – Infection management -Rule based, IF and THEN rules. PUFF – LIS for interpretation of Pulmonary function test. 1976 INTERNIST 1 – diagnosis 1974 AAPHELP –Leeds Abdominal Pain System 1972
Knowledge at the point of care
Apply the best evidence
Serve as a peripheral brain – assist
Decision making – enhance communication.
Improve Healthcare processes and Outcomes.
The Information Overload
Clinical decision making Paul Gorman, Medical Decision Making 1995
Clinical Workflow: How does CDSS fit?
CDSS application areas
CDSS - Applications
Alerts and reminders
Therapy critiquing and planning
Prescribing decision support systems
Image recognition and interpretation
Diagnostic and educational systems
CDSS Functions - trend
Managing clinical complexity details
An Effective CDSS should:
Fit in to user’s Workflow
Alerts should be descriptive
Effective CDSS features contd.
Prompt Additional Information only when required
Monitor impact, feedback and respond
Manage and maintain Knowledge Based system
Ten Commandments for Effective Clinical Decision Support: Making the Practice of Evidence-based Medicine a Reality. David W. Bates, MD, MSc, Division of General Medicine and Primary Care, Brigham and Women's Hospital, May 27, 2003
Patient Safety – Error Reduction/prevention
Cost Reduction – without compromising care
Promoting best practice – Enforcing compliance (Practice Guidelines)
What makes CDSS possible?
Machine Learning Systems/Expert Systems
Create new knowledge
Expressed as RULES or decision aids.
KARDIO – for interpreting ECG
A Study in Deep and Qualitative Knowledge for Expert Systems Ivan Bratko , et al., Nov 1989