Clinical Decision Support
The Road Ahead
- 1st Edition - November 24, 2006
- Editor: Robert Greenes
- Language: English
This book examines the nature of medical knowledge, how it is obtained, and how it can be used for decision support. It provides complete coverage of computational approaches to… Read more
This book examines the nature of medical knowledge, how it is obtained, and how it can be used for decision support. It provides complete coverage of computational approaches to clinical decision-making. Chapters discuss data integration into healthcare information systems and delivery to point of care for providers, as well as facilitation of direct to consumer access. A case study section highlights critical lessons learned, while another portion of the work examines biostatistical methods including data mining, predictive modelling, and analysis. This book additionally addresses organizational, technical, and business challenges in order to successfully implement a computer-aided decision-making support system in healthcare delivery.
Health care professionals, medical informatics researchers and students, policy makers, IT development managers, and various clinical investigators
Contributors
Preface
I: Computer-based clinical decision support: Concepts and origins
Chapter 1: Definition, scope, and challenges
1.1 INTRODUCTION
1.2 DEFINITION OF COMPUTER-BASED CLINICAL DECISION SUPPORT
1.3 FEATURES OF CDS
1.4 THE TALE OF A RELATIONSHIP
1.5 SCOPE AND PLAN OF THIS BOOK
REFERENCES
Chapter 2: A Brief history of clinical decision support
2.1 PRIMARY RESEARCH METHODOLOGIES THAT HAVE BEEN PURSUED AND EXTENDED
2.2 DRIVING FORCES FOR CDS
2.3 CONCLUSION
REFERENCES
Chapter 3: Features of computer-based clinical decision support
3.1 CDS AND THE HUMAN
3.2 DESIGN AND STRUCTURE OF CDS
3.3 OTHER CONSIDERATIONS
REFERENCES
II: Case studies and current status
Chapter 4: Regenstrief medical informatics
4.1 INTRODUCTION
4.2 HISTORY
4.3 CONCLUSION
REFERENCES
Chapter 5: Patients, doctors, and information technology
5.1 HISTORY
5.2 CLINICAL DECISION SUPPORT AND INPATIENT CPOE AT BWH
5.3 DECISION SUPPORT DELIVERED USING THE OUTPATIENT ELECTRONIC HEALTH RECORD
5.4 OVERARCHING STUDIES
5.5 OVERARCHING LESSONS
5.6 FUTURE DIRECTIONS
REFERENCES
Chapter 6: Case studies in clinical decision support
6.1 INTRODUCTION
6.2 TOOLS FOR INFORMATION MANAGEMENT
6.3 TOOLS FOR FOCUSING ATTENTION
6.4 TOOLS FOR PATIENT-SPECIFIC CONSULTATION
6.5 CONCLUSION
REFERENCES
Chapter 7: Penetration and availability of clinical decision support in commercial systems
7.1 INTRODUCTION
7.2 CDS PENETRATION AND AVAILABILITY IN COMMERCIAL SYSTEMS
7.3 CLINICAL ALERTING IN 2002
7.4 OBSTACLES TO CDS IN 2002
7.5 WHAT CHANGED SINCE EARLY 2002?
7.6 HOW FAR ALONG ARE CDS VENDORS IN 2005?
7.7 SELF-REPORTED VENDOR DATA AS OF FEBRUARY 2005
7.8 CONCLUSION
REFERENCES
VENDOR WEB SITE REFERENCES
Chapter 8: Lessons learned
8.1 ACADEMIC PROTOTYPES
8.2 STANDARDS AND SHARING OF INTEROPERABLE CONTENT AND TOOLS
8.3 USERS
8.4 OTHER CONSIDERATIONS
REFERENCES
III: Generation and formulation of knowledge
Chapter 9: Human-Intensive techniques
9.1 INTRODUCTION
9.2 THEORETICAL BASIS FOR KNOWLEDGE ACQUISITION
9.3 COGNITIVE TASK ANALYSIS
9.4 COMPUTER-BASED KNOWLEDGE ACQUISITION
9.5 CONCLUSION
REFERENCES
Chapter 10: Generation of knowledge for clinical decision support
10.1 INTRODUCTION
10.2 LEARNING FROM DATA
10.3 OVERVIEW OF LOGISTIC REGRESSION
10.4 OVERVIEW OF SOME MACHINE LEARNING MODELS
10.5 PREDICTION MODELS IN MEDICINE
10.6 CONCLUSION
REFERENCES
Chapter 11: Evidence-based medicine and meta-analysis
11.1 SYSTEMATIC REVIEWS AND META-ANALYSES
11.2 METHODOLOGIES OF SYSTEMATIC REVIEW AND META-ANALYSIS
11.3 DEVELOPING A SYSTEMATIC REVIEW PROTOCOL
11.4 FORMULATING THE RESEARCH QUESTION
11.5 LITERATURE SEARCH
11.6 DATA EXTRACTION
11.7 ASSESSING THE QUALITY OF STUDIES
11.8 COMBINING DATA IN A META-ANALYSIS
11.9 EXPLORING HETEROGENEITY WITH SUBGROUP AND META-REGRESSION ANALYSES
11.10 ISSUES IN CONDUCTING META-ANALYSES
11.11 USES OF SYSTEMATIC REVIEWS AND META-ANALYSES
11.12 ACCESSING SYSTEMATIC REVIEWS AND META-ANALYSES AND RELATED PRODUCTS
11.13 CONCLUSION
REFERENCES
IV: Representing the knowledge
Chapter 12: Decision rules and expressions
12.1 INTRODUCTION
12.2 PROCEDURAL KNOWLEDGE
12.3 KNOWLEDGE AS PRODUCTION RULES
12.4 THE HYBRID APPROACH: ARDEN SYNTAX
12.5 EXPRESSION LANGUAGES
12.6 FUTURE WORK
12.7 CONCLUSION
REFERENCES
Chapter 13: Guidelines and workflow models
13.1 INTRODUCTION: CLINICAL GUIDELINES AND ALGORITHMS
13.2 THE KNOWLEDGE CONTAINED IN CLINICAL GUIDELINES
13.3 FORMAL METHODS FOR SPECIFYING CIGS
13.4 FROM NARRATIVE TO FORMAL REPRESENTATIONS OF GUIDELINES
13.5 INTEGRATION OF GUIDELINES WITH WORKFLOW
13.6 METHODS FOR SHARING OF CIG CONTENT
13.7 CONCLUSION
13.8 RECOMMENDED RESOURCES
ACKNOWLEDGMENTS
REFERENCES
Chapter 14: Ontologies, vocabularies, and data models
14.1 INTRODUCTION
14.2 THE NEED FOR CODED DATA
14.3 REFERENCING DATA IN DECISION LOGIC
14.4 ISSUES OF PRE- AND POSTCOORDINATION
14.5 DATA REPRESENTATION USING NAME-VALUE PAIRS
14.6 TERMINOLOGY IN THE LIFE CYCLE OF DECISION SUPPORT PROGRAMS
14.7 CONTEXTUAL RESTRICTIONS WITHIN THE TERMINOLOGY
14.8 WHAT NEEDS TO BE DONE
REFERENCES
Chapter 15: Grouped knowledge elements
15.1 INTRODUCTION
15.2 CLINICAL DOCUMENTATION
15.3 CURRENT APPROACHES TO CLINICAL DOCUMENTATION
15.4 GROUPED KNOWLEDGE ELEMENTS (KEGs)
15.5 CONCLUSION
REFERENCES
Chapter 16: Infobuttons and point of care access to knowledge
16.1 INTRODUCTION
16.2 UNDERSTANDING AND ADDRESSING CLINICIAN INFORMATION NEEDS
16.3 LINKING CLINICAL INFORMATION SYSTEMS TO ONLINE RESOURCES
16.4 INFOBUTTONS
16.5 MANAGING INFOBUTTONS
16.6 INFOBUTTON STANDARDIZATION
16.7 STANDARDS FOR INFORMATION RESOURCES
16.8 CONCLUSION
RECOMMENDED RESOURCES
ACKNOWLEDGMENTS
REFERENCES
Chapter 17: The role of standards
17.1 KEY STANDARDS AND THEIR BENEFITS
17.2 HOW IMPORTANT ARE STANDARDS?
REFERENCES
V: Organizational, business, and social challenges
Chapter 18: Organizational and cultural change considerations
18.1 INTRODUCTION
18.2 ORGANIZATIONAL ISSUES RELATED TO CLINICAL DECISION SUPPORT
18.3 PLANNING WITH THESE ISSUES IN MIND
18.4 DEVELOPMENT, IMPLEMENTATION, AND MODIFICATION
18.5 EVALUATION AND MAINTENANCE
18.6 CONCLUSION
RESOURCES
ACKNOWLEDGMENTS
REFERENCES
Chapter 19: Managing the investment in clinical decision support
19.1 INTRODUCTION
19.2 KNOWLEDGE MANAGEMENT
19.3 ORGANIZATION OF THE EFFORT
19.4 KEY IT STRATEGIES AND CONSIDERATIONS
19.5 EVALUATION OF THE IMPACT AND VALUE OF KNOWLEDGE MANAGEMENT
19.6 CONCLUSION
REFERENCES
Chapter 20: Legal and regulatory issues related to the use of clinical software in health care delivery
20.1 INTRODUCTION
20.2 LEGAL ISSUES RELATED TO USING EMBEDDED AND FREE-STANDING DECISION SUPPORT SOFTWARE IN CLINICAL SETTINGS
20.3 RESPONSIBILITY FOR CDS SOFTWARE AT THE INSTITUTIONAL LEVEL AND POTENTIAL GOVERNMENTAL REGULATION
20.4 CONCLUSION
ACKNOWLEDGMENTS
REFERENCES
VI: Knowledge management approaches
Chapter 21: Knowledge management infrastructure
21.1 INTRODUCTION
21.2 RAPID INNOVATION DISCOVERY AND ADOPTION: KEY INFRASTRUCTURE REQUIREMENTS
21.3 KNOWLEDGE ASSET MANAGEMENT INFRASTRUCTURE
21.4 CONCLUSION
REFERENCES
Chapter 22: The clinical knowledge management infrastructure of intermountain healthcare
22.1 CLINICAL KNOWLEDGE MANAGEMENT AT INTERMOUNTAIN HEALTHCARE
22.2 KNOWLEDGE ASSETS
22.3 SOFTWARE INFRASTRUCTURE
ACKNOWLEDGMENTS
REFERENCES
Chapter 23: Integration of knowledge resources into applications to enable clinical decision support
23.1 INTRODUCTION
23.2 TERM DEFINITIONS
23.3 KNOWLEDGE INTEGRATION TASKS
23.4 ARCHITECTURAL CONSIDERATIONS
23.5 CASE STUDIES
23.6 LESSONS LEARNED FROM MARKET ADOPTION PATTERNS
23.7 PROPOSAL FOR A SOA APPROACH TO CLINICAL DECISION SUPPORT
23.8 CONCLUSION
RECOMMENDED RESOURCES
ACKNOWLEDGMENTS
REFERENCES
VII: The road ahead
Chapter 24: A proposed strategy for overcoming inertia
24.1 EXISTING APPROACHES NOT WORKING
24.2 NEED FOR NEW MECHANISMS
24.3 RATIONALE FOR COMMUNAL INFRASTRUCTURE, RESOURCES, AND TOOLS
24.4 ORGANIZATION OF PROCESS
24.5 OVERVIEW OF STRATEGY
24.6 IDENTIFYING KEY SOCIETAL DRIVERS AND SETTING PRIORITIES
24.7 FORMALIZING THE THREE LIFE CYCLE PROCESSES
24.8 GETTING SPECIFIC: END-TO-END IMPLEMENTATION STARTING WITH HIGH-PRIORITY FOCUS AREA(s)
24.9 LOOKING AHEAD: EPILOGUE AS PROLOGUE
REFERENCES
Index
- Edition: 1
- Published: November 24, 2006
- Language: English
RG
Robert Greenes
Robert Greenes, MD, PhD, holds an MD and a PhD in Computer Science from Harvard. Dr Greenes is an expert in health care information technology/informatics and has made contributions to the field over many years, initially at Harvard and more recently at Arizona State University in partnership with Mayo Clinic. His passion is the use of information technology in health care to make "the right thing the easy thing to do". He is Ira A. Fulton Chair of Biomedical Informatics at the ASU, a member of the National Academy of Medicine and of the International Academy of Health Sciences Informatics, and a Fellow of the American College of Radiology, American College of Medical Informatics, and the Society for Imaging Informatics in Medicine. He was the 2008 recipient of the Morris F. Collen Award for lifetime impact on the field of biomedical informatics, from the American College of Medical Informatics.
Affiliations and expertise
Emeritus Professor of Biomedical Informatics, Arizona State University, Phoenix, AZ, United StatesRead Clinical Decision Support on ScienceDirect