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.
Inhaltsverzeichnis
1;Front Cover;1 2;Clinical Decision Support;4 3;Copyright Page;5 4;Table of Contents;6 5;Contributors;10 6;Preface;12 7;PART I COMPUTER-BASED CLINICAL DECISION SUPPORT: CONCEPTS AND ORIGINS;18 7.1;Chapter 1 DEFINITION, SCOPE, AND CHALLENGES;20 7.1.1;1.1 INTRODUCTION;20 7.1.2;1.2 DEFINITION OF COMPUTER-BASED CLINICAL DECISION SUPPORT;23 7.1.3;1.3 FEATURES OF CDS;23 7.1.4;1.4 THE TALE OF A RELATIONSHIP;24 7.1.5;1.5 SCOPE AND PLAN OF THIS BOOK;39 7.1.6;REFERENCES;43 7.2;Chapter 2 A BRIEF HISTORY OF CLINICAL DECISION SUPPORT: TECHNICAL, SOCIAL, CULTURAL, ECONOMIC, AND GOVERNMENTAL PERSPECTIVES;48 7.2.1;2.1 PRIMARY RESEARCH METHODOLOGIES THAT HAVE BEEN PURSUED AND EXTENDED;48 7.2.2;2.2 DRIVING FORCES FOR CDS;75 7.2.3;2.3 CONCLUSION;86 7.2.4;REFERENCES;86 7.3;Chapter 3 FEATURES OF COMPUTER-BASED CLINICAL DECISION SUPPORT;96 7.3.1;3.1 CDS AND THE HUMAN;97 7.3.2;3.2 DESIGN AND STRUCTURE OF CDS;103 7.3.3;3.3 OTHER CONSIDERATIONS;121 7.3.4;REFERENCES;122 8;PART II CASE STUDIES AND CURRENT STATUS;126 8.1;Chapter 4 REGENSTRIEF MEDICAL INFORMATICS: EXPERIENCES WITH CLINICAL DECISION SUPPORT SYSTEMS;128 8.1.1;4.1 INTRODUCTION;128 8.1.2;4.2 HISTORY;129 8.1.3;4.3 CONCLUSION;140 8.1.4;REFERENCES;142 8.2;Chapter 5 PATIENTS, DOCTORS, AND INFORMATION TECHNOLOGY: CLINICAL DECISION SUPPORT AT BRIGHAM AND WOMENS HOSPITAL AND PARTNERS;144 8.2.1;5.1 HISTORY;144 8.2.2;5.2 CLINICAL DECISION SUPPORT AND INPATIENT CPOE AT BWH;146 8.2.3;5.3 DECISION SUPPORT DELIVERED USING THE OUTPATIENT ELECTRONIC HEALTH RECORD;151 8.2.4;5.4 OVERARCHING STUDIES;154 8.2.5;5.5 OVERARCHING LESSONS;155 8.2.6;5.6 FUTURE DIRECTIONS;156 8.2.7;REFERENCES;157 8.3;Chapter 6 CASE STUDIES IN CLINICAL DECISION SUPPORT: LDS HOSPITAL EXPERIENCE;160 8.3.1;6.1 INTRODUCTION;160 8.3.2;6.2 TOOLS FOR INFORMATION MANAGEMENT;163 8.3.3;6.3 TOOLS FOR FOCUSING ATTENTION;167 8.3.4;6.4 TOOLS FOR PATIENT-SPECIFIC CONSULTATION;175 8.3.5;6.5 CONCLUSION;180 8.3.6;REFERENCES;182 8.4;Chapter 7 PENETRATION AND AVAILABILITY OF CLINICAL DECISION S
UPPORT IN COMMERCIAL SYSTEMS;186 8.4.1;7.1 INTRODUCTION;186 8.4.2;7.2 CDS PENETRATION AND AVAILABILITY IN COMMERCIAL SYSTEMS;187 8.4.3;7.3 CLINICAL ALERTING IN 2002;189 8.4.4;7.4 OBSTACLES TO CDS IN 2002;191 8.4.5;7.5 WHAT CHANGED SINCE EARLY 2002?;193 8.4.6;7.6 HOW FAR ALONG ARE CDS VENDORS IN 2005?;201 8.4.7;7.7 SELF-REPORTED VENDOR DATA AS OF FEBRUARY 2005;201 8.4.8;7.8 CONCLUSION;209 8.4.9;REFERENCES;210 8.4.10;VENDOR WEB SITE REFERENCES;211 8.5;Chapter 8 LESSONS LEARNED;212 8.5.1;8.1 ACADEMIC PROTOTYPES;213 8.5.2;8.2 STANDARDS AND SHARING OF INTEROPERABLE CONTENT AND TOOLS;217 8.5.3;8.3 USERS;218 8.5.4;8.4 OTHER CONSIDERATIONS;219 8.5.5;REFERENCES;220 9;PART III GENERATION AND FORMULATION OF KNOWLEDGE;222 9.1;Chapter 9 HUMAN-INTENSIVE TECHNIQUES;224 9.1.1;9.1 INTRODUCTION;224 9.1.2;9.2 THEORETICAL BASIS FOR KNOWLEDGE ACQUISITION;227 9.1.3;9.3 COGNITIVE TASK ANALYSIS;229 9.1.4;9.4 COMPUTER-BASED KNOWLEDGE ACQUISITION;237 9.1.5;9.5 CONCLUSION;239 9.1.6;REFERENCES;240 9.2;Chapter 10 GENERATION OF KNOWLEDGE FOR CLINICAL DECISION SUPPORT: STATISTICAL AND MACHINE LEARNING TECHNIQUES;244 9.2.1;10.1 INTRODUCTION;244 9.2.2;10.2 LEARNING FROM DATA;246 9.2.3;10.3 OVERVIEW OF LOGISTIC REGRESSION;247 9.2.4;10.4 OVERVIEW OF SOME MACHINE LEARNING MODELS;250 9.2.5;10.5 PREDICTION MODELS IN MEDICINE;253 9.2.6;10.6 CONCLUSION;258 9.2.7;REFERENCES;259 9.3;Chapter 11 EVIDENCE-BASED MEDICINE AND META-ANALYSIS: GETTING MORE OUT OF THE LITERATURE;266 9.3.1;11.1 SYSTEMATIC REVIEWS AND META-ANALYSES;267 9.3.2;11.2 METHODOLOGIES OF SYSTEMATIC REVIEW AND META-ANALYSIS;268 9.3.3;11.3 DEVELOPING A SYSTEMATIC REVIEW PROTOCOL;268 9.3.4;11.4 FORMULATING THE RESEARCH QUESTION;269 9.3.5;11.5 LITERATURE SEARCH;270 9.3.6;11.6 DATA EXTRACTION;271 9.3.7;11.7 ASSESSING THE QUALITY OF STUDIES;271 9.3.8;11.8 COMBINING DATA IN A META-ANALYSIS;272 9.3.9;11.9 EXPLORING HETEROGENEITY WITH SUBGROUP AND META-REGRESSION ANALYSES;272 9.3.10;11.10 ISSUES IN CONDUCTING META-ANALYSES;273 9.3.11;11.11 USES OF SYS
TEMATIC REVIEWS AND META-ANALYSES;276 9.3.12;11.12 ACCESSING SYSTEMATIC REVIEWS AND META-ANALYSES AND RELATED PRODUCTS;277 9.3.13;11.13 CONCLUSION;278 9.3.14;REFERENCES;279 10;PART IV REPRESENTING THE KNOWLEDGE: STANDARDIZATION EFFORTS;282 10.1;Chapter 12 DECISION RULES AND EXPRESSIONS;284 10.1.1;12.1 INTRODUCTION;284 10.1.2;12.2 PROCEDURAL KNOWLEDGE;285 10.1.3;12.3 KNOWLEDGE AS PRODUCTION RULES;286 10.1.4;12.4 THE HYBRID APPROACH: ARDEN SYNTAX;290 10.1.5;12.5 EXPRESSION LANGUAGES;294 10.1.6;12.6 FUTURE WORK;295 10.1.7;12.7 CONCLUSION;296 10.1.8;REFERENCES;296 10.2;Chapter 13 GUIDELINES AND WORKFLOW MODELS;298 10.2.1;13.1 INTRODUCTION: CLINICAL GUIDELINES AND ALGORITHMS;298 10.2.2;13.2 THE KNOWLEDGE CONTAINED IN CLINICAL GUIDELINES;300 10.2.3;13.3 FORMAL METHODS FOR SPECIFYING CIGS;302 10.2.4;13.4 FROM NARRATIVE TO FORMAL REPRESENTATIONS OF GUIDELINES;311 10.2.5;13.5 INTEGRATION OF GUIDELINES WITH WORKFLOW;312 10.2.6;13.6 METHODS FOR SHARING OF CIG CONTENT;314 10.2.7;13.7 CONCLUSION;317 10.2.8;13.8 RECOMMENDED RESOURCES;320 10.2.9;ACKNOWLEDGMENTS;321 10.2.10;REFERENCES;321 10.3;Chapter 14 ONTOLOGIES, VOCABULARIES, AND DATA MODELS;324 10.3.1;14.1 INTRODUCTION;324 10.3.2;14.2 THE NEED FOR CODED DATA;324 10.3.3;14.3 REFERENCING DATA IN DECISION LOGIC;325 10.3.4;14.4 ISSUES OF PRE- AND POSTCOORDINATION;328 10.3.5;14.5 DATA REPRESENTATION USING NAME-VALUE PAIRS;330 10.3.6;14.6 TERMINOLOGY IN THE LIFE CYCLE OF DECISION SUPPORT PROGRAMS;333 10.3.7;14.7 CONTEXTUAL RESTRICTIONS WITHIN THE TERMINOLOGY;336 10.3.8;14.8 WHAT NEEDS TO BE DONE;339 10.3.9;REFERENCES;340 10.4;Chapter 15 GROUPED KNOWLEDGE ELEMENTS;342 10.4.1;15.1 INTRODUCTION;342 10.4.2;15.2 CLINICAL DOCUMENTATION;344 10.4.3;15.3 CURRENT APPROACHES TO CLINICAL DOCUMENTATION;348 10.4.4;15.4 GROUPED KNOWLEDGE ELEMENTS (KEGs);352 10.4.5;15.5 CONCLUSION;358 10.4.6;REFERENCES;359 10.5;Chapter 16 INFOBUTTONS AND POINT OF CARE ACCESS TO KNOWLEDGE;362 10.5.1;16.1 INTRODUCTION;362 10.5.2;16.2 UNDERSTANDING AND ADDRESSING CLIN
ICIAN INFORMATION NEEDS;363 10.5.3;16.3 LINKING CLINICAL INFORMATION SYSTEMS TO ONLINE RESOURCES;366 10.5.4;16.4 INFOBUTTONS;367 10.5.5;16.5 MANAGING INFOBUTTONS;373 10.5.6;16.6 INFOBUTTON STANDARDIZATION;380 10.5.7;16.7 STANDARDS FOR INFORMATION RESOURCES;383 10.5.8;16.8 CONCLUSION;384 10.5.9;RECOMMENDED RESOURCES;384 10.5.10;ACKNOWLEDGMENTS;385 10.5.11;REFERENCES;385 10.6;Chapter 17 THE ROLE OF STANDARDS: WHAT WE CAN EXPECT AND WHEN;390 10.6.1;17.1 KEY STANDARDS AND THEIR BENEFITS;390 10.6.2;17.2 HOW IMPORTANT ARE STANDARDS?;396 10.6.3;REFERENCES;398 11;PART V ORGANIZATIONAL, BUSINESS, AND SOCIAL CHALLENGES;400 11.1;Chapter 18 ORGANIZATIONAL AND CULTURAL CHANGE CONSIDERATIONS;402 11.1.1;18.1 INTRODUCTION;402 11.1.2;18.2 ORGANIZATIONAL ISSUES RELATED TO CLINICAL DECISION SUPPORT;405 11.1.3;18.3 PLANNING WITH THESE ISSUES IN MIND;411 11.1.4;18.4 DEVELOPMENT, IMPLEMENTATION, AND MODIFICATION;413 11.1.5;18.5 EVALUATION AND MAINTENANCE;416 11.1.6;18.6 CONCLUSION;417 11.1.7;RESOURCES;418 11.1.8;ACKNOWLEDGMENTS;418 11.1.9;REFERENCES;418 11.2;Chapter 19 MANAGING THE INVESTMENT IN CLINICAL DECISION SUPPORT;420 11.2.1;19.1 INTRODUCTION;420 11.2.2;19.2 KNOWLEDGE MANAGEMENT;421 11.2.3;19.3 ORGANIZATION OF THE EFFORT;424 11.2.4;19.4 KEY IT STRATEGIES AND CONSIDERATIONS;431 11.2.5;19.5 EVALUATION OF THE IMPACT AND VALUE OF KNOWLEDGE MANAGEMENT;435 11.2.6;19.6 CONCLUSION;438 11.2.7;REFERENCES;439 11.3;Chapter 20 LEGAL AND REGULATORY ISSUES RELATED TO THE USE OF CLINICAL SOFTWARE IN HEALTH CARE DELIVERY;440 11.3.1;20.1 INTRODUCTION;440 11.3.2;20.2 LEGAL ISSUES RELATED TO USING EMBEDDED AND FREE-STANDING DECISION SUPPORT SOFTWARE IN CLINICAL SETTINGS;440 11.3.3;20.3 RESPONSIBILITY FOR CDS SOFTWARE AT THE INSTITUTIONAL LEVEL AND POTENTIAL GOVERNMENTAL REGULATION;454 11.3.4;20.4 CONCLUSION;459 11.3.5;ACKNOWLEDGMENTS;459 11.3.6;REFERENCES;460 12;PART VI KNOWLEDGE MANAGEMENT APPROACHES;462 12.1;Chapter 21 KNOWLEDGE MANAGEMENT INFRASTRUCTURE: EVOLUTION AT PARTNERS HEALTHCARE SYSTEM;464
12.1.1;21.1 INTRODUCTION;464 12.1.2;21.2 RAPID INNOVATION DISCOVERY AND ADOPTION: KEY INFRASTRUCTURE REQUIREMENTS;465 12.1.3;21.3 KNOWLEDGE ASSET MANAGEMENT INFRASTRUCTURE;468 12.1.4;21.4 CONCLUSION;482 12.1.5;REFERENCES;483 12.2;Chapter 22 THE CLINICAL KNOWLEDGE MANAGEMENT INFRASTRUCTURE OF INTERMOUNTAIN HEALTHCARE;486 12.2.1;22.1 CLINICAL KNOWLEDGE MANAGEMENT AT INTERMOUNTAIN HEALTHCARE;486 12.2.2;22.2 KNOWLEDGE ASSETS;489 12.2.3;22.3 SOFTWARE INFRASTRUCTURE;503 12.2.4;ACKNOWLEDGMENTS;517 12.2.5;REFERENCES;517 12.3;Chapter 23 INTEGRATION OF KNOWLEDGE RESOURCES INTO APPLICATIONS TO ENABLE CLINICAL DECISION SUPPORT: ARCHITECTURAL CONSIDERATIONS;520 12.3.1;23.1 INTRODUCTION;521 12.3.2;23.2 TERM DEFINITIONS;521 12.3.3;23.3 KNOWLEDGE INTEGRATION TASKS;522 12.3.4;23.4 ARCHITECTURAL CONSIDERATIONS;525 12.3.5;23.5 CASE STUDIES;533 12.3.6;23.6 LESSONS LEARNED FROM MARKET ADOPTION PATTERNS;542 12.3.7;23.7 PROPOSAL FOR A SOA APPROACH TO CLINICAL DECISION SUPPORT;545 12.3.8;23.8 CONCLUSION;553 12.3.9;RECOMMENDED RESOURCES;553 12.3.10;ACKNOWLEDGMENTS;554 12.3.11;REFERENCES;554 13;PART VII THE ROAD AHEAD;556 13.1;Chapter 24 A PROPOSED STRATEGY FOR OVERCOMING INERTIA;558 13.1.1;24.1 EXISTING APPROACHES NOT WORKING;558 13.1.2;24.2 NEED FOR NEW MECHANISMS;559 13.1.3;24.3 RATIONALE FOR COMMUNAL INFRASTRUCTURE, RESOURCES, AND TOOLS;561 13.1.4;24.4 ORGANIZATION OF PROCESS;564 13.1.5;24.5 OVERVIEW OF STRATEGY;565 13.1.6;24.6 IDENTIFYING KEY SOCIETAL DRIVERS AND SETTING PRIORITIES;566 13.1.7;24.7 FORMALIZING THE THREE LIFE CYCLE PROCESSES;571 13.1.8;24.8 GETTING SPECIFIC: END-TO-END IMPLEMENTATION STARTING WITH HIGH-PRIORITY FOCUS AREA(s);580 13.1.9;24.9 LOOKING AHEAD: EPILOGUE AS PROLOGUE;584 13.1.10;REFERENCES;585 13.2;INDEX;588
