decision sppurt system

1. Clinical Decision Support Systems
Chapter 20

2. 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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3. 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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4. 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 current
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5. 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 knowledge
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6. 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 diagnosis
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7. 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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8. 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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9. 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.
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10. 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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11. Historical Perspective
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Example

12. 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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13. 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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14. 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 Tools 14

15. 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

16. 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 16

17. EON System
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18. Legal and Regulatory Issues
 Negligence Law
 Strict liability
 Validation of tools prior to release
 Role of government in regulation
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