Clinical Decision Support Systems: Theory and Practice

Cover......Page 1
Series Preface......Page 5
Preface......Page 6
Contents......Page 8
Contributors......Page 10
Types of Clinical Decision Support Systems......Page 15
Effectiveness of Clinical Decision Support Systems......Page 20
Implementation Challenges......Page 23
Future Uses of Clinical Decision Support Systems......Page 24
Guidelines for Selecting and Implementing Clinical Decision Support Systems†......Page 25
Conclusion......Page 30
Review of Logic and Probability......Page 35
The General Model of Knowledge-Based Decision Support Systems......Page 46
Nonknowledge-Based Systems......Page 52
Summary......Page 53
Introduction......Page 56
Data Mining and Clinical Decision Support Systems......Page 57
Supervised Versus Unsupervised Learning......Page 59
Classifiers for Supervised Learning......Page 61
Evaluation of Classifiers......Page 66
Unsupervised Learning......Page 69
Other Techniques......Page 71
Conclusions......Page 73
4. Design and Implementation Issues......Page 76
Technical Design Issues......Page 77
Reasoning......Page 83
Knowledge Acquisition......Page 91
Human–Computer Interaction......Page 102
Conclusion......Page 104
Definitions of Diagnosis......Page 111
Human Diagnostic Reasoning......Page 116
Historical Survey of Diagnostic Decision Support Systems......Page 119
Developing, Implementing, Evaluating, and Maintaining Diagnostic Decision Support Systems......Page 123
The Future of Diagnostic Decision Support Systems......Page 132
6. Ethical and Legal Issues in Decision Support......Page 138
Ethical Issues......Page 139
Legal and Regulatory Issues......Page 145
Conclusion and Future Directions......Page 149
The Practical and Scientific Need for Clinical Testing......Page 152
Research Methods to Demonstrate Practical Impact......Page 154
User Satisfaction with Decision Support Systems......Page 155
Randomized Controlled Clinical Trials of Decision-Support Services......Page 156
Columbia Registry of Medical Management Trials......Page 158
8. Clinical Decision Support at Intermountain Healthcare......Page 169
The Help System......Page 171
Alerting Systems......Page 173
Critiquing Systems......Page 176
Suggestion Systems......Page 178
Diagnostic Decision Support in the Help System......Page 180
Proven Diagnostic Applications......Page 181
Research into Complex Diagnostic Applications......Page 185
Intermountain Healthcare’s Clinical Knowledge Management Infrastructure......Page 191
Summary......Page 195
Reminders and Guidelines—A History of Regenstrief Medical Record System Decision Support*......Page 200
Beyond Reminders—Other Uses of Our General Decision Logic......Page 209
Other Decision-Support Mechanisms......Page 211
Architecture of the Regenstrief Medical Record System......Page 216
Lessons from More Than a Quarter Century of Experience with Computerized Decision Support......Page 220
Introduction......Page 225
Basic Care Provider Order Entry System Functionality......Page 226
Philosophy Underlying Decision Support During Care Provider Order Entry......Page 232
Roles for Decision Support Within Care Provider Order Entry: Categories of Interventions......Page 235
Critical Points at Which to Implement Decision Support Within Care Provider Order Entry......Page 238
Care Provider Order Entry Intervention Approaches— from Subtle to Intrusive......Page 247
Conclusion......Page 252
Role of Consumer Health Informatics in Patient Care......Page 259
Health Information and Decision Support Systems for Patients......Page 261
Helping Patients Judge the Quality of Health Information......Page 265
Patient Access to Decision Support Systems......Page 266
The Future of Decision Support Systems for Patients......Page 268
Index......Page 272