Berner Clinical Decision Support Systems

Theory and Practice
3rd Auflage 2016
ISBN: 978-3-319-31913-1
Verlag: Springer Nature Switzerland
Format: PDF
Kopierschutz: 1 - PDF Watermark

E-Book, Englisch, 319 Seiten

Reihe: Health Informatics

Building on the success of the previous editions, this fully updated book once again brings together worldwide experts to illustrate the underlying science and day-to-day use of decision support systems in clinical and educational settings.Topics discussed include:-Mathematical Foundations of Decision Support Systems
-Design and Implementation Issues
-Ethical and Legal Issues in Decision Support
-Clinical Trials of Information Interventions
-Hospital-Based Decision Support
-Real World Case Studies 

Eta S. Berner, EdD, is a Professor of Health Informatics at the University of Alabama at Birmingham.

Autoren/Hrsg.

Berner, Eta S.

Inhaltsverzeichnis

1;Preface;6
2;Contents;8
3;Contributors;10
4;Chapter 1: Overview of Clinical Decision Support Systems;13
4.1;1.1 Types of Clinical Decision Support Systems;14
4.1.1;1.1.1 Knowledge-Based Clinical Decision Support Systems;15
4.1.2;1.1.2 Nonknowledge-Based Clinical Decision Support Systems;17
4.2;1.2 Effectiveness of Clinical Decision Support Systems;17
4.3;1.3 Implementation Challenges;20
4.4;1.4 Future Uses of Clinical Decision Support Systems;21
4.5;1.5 Guidelines for Selecting and Implementing Clinical Decision Support Systems;22
4.5.1;1.5.1 Assuring That Users Understand the Limitations;22
4.5.2;1.5.2 Assuring That the Knowledge Is from Reputable Sources;23
4.5.3;1.5.3 Assuring That the System Is Appropriate for the Local Site;23
4.5.4;1.5.4 Assuring That Users Are Properly Trained;24
4.5.5;1.5.5 Monitoring Proper Utilization of the Installed Clinical Decision Support Systems;25
4.5.6;1.5.6 Assuring the Knowledge Base Is Monitored and Maintained;25
4.6;1.6 Conclusion;26
4.7;References;26
5;Chapter 2: Mathematical Foundations of Decision Support Systems;30
5.1;2.1 Review of Logic and Probability;31
5.1.1;2.1.1 Set Theory;31
5.1.2;2.1.2 Boolean Logic;34
5.1.3;2.1.3 Probability;37
5.1.4;2.1.4 Bayes’ Rule;39
5.1.5;2.1.5 Informal Logic;41
5.2;2.2 The General Model of Knowledge-Based Decision Support Systems;42
5.2.1;2.2.1 Input;43
5.2.2;2.2.2 Inference Engine;45
5.2.3;2.2.3 Knowledge Base;47
5.2.4;2.2.4 Output;47
5.3;2.3 Nonknowledge-Based Systems;47
5.3.1;2.3.1 Neural Networks;48
5.3.2;2.3.2 Genetic Algorithms;49
5.4;2.4 Model for Evaluating the Appropriateness of CDSS;49
5.5;2.5 Summary;51
5.6;References;51
6;Chapter 3: Data Mining and Clinical Decision Support Systems;55
6.1;3.1 Introduction;55
6.2;3.2 Data Mining and Clinical Decision Support Systems;56
6.3;3.3 Data Mining and Statistical Pattern Recognition;58
6.4;3.4 Supervised Versus Unsupervised Learning;59
6.4.1;3.4.1 Supervised Learning;59
6.4.2;3.4.2 A Priori Probability;60
6.4.3;3.4.3 Unsupervised Learning;60
6.4.4;3.4.4 Classifiers for Supervised Learning;61
6.4.5;3.4.5 Decision Trees;61
6.4.6;3.4.6 Logistic Regression;62
6.4.7;3.4.7 Neural Networks;64
6.4.8;3.4.8 Nearest Neighbor Classifier;65
6.5;3.5 Evaluation of Classifiers;66
6.5.1;3.5.1 ROC Graphs;66
6.5.2;3.5.2 Kolmogorov-Smirnov Test;68
6.6;3.6 Unsupervised Learning;69
6.6.1;3.6.1 Cluster Analysis;69
6.6.2;3.6.2 Gene Expression Data Analysis;70
6.7;3.7 Other Techniques;71
6.7.1;3.7.1 Genetic Algorithms;71
6.7.2;3.7.2 Biological Computing;72
6.7.3;3.7.3 Quantum Computing;73
6.7.4;3.7.4 Incorporating Fuzzy Logic and Other Hybrid Methods;74
6.7.5;3.7.5 Big Data Analytics;74
6.8;3.8 Conclusions;75
6.9;References;75
7;Chapter 4: Usability and Clinical Decision Support;79
7.1;4.1 CDSS Usability and Functionality;79
7.1.1;4.1.1 Clinical Challenges;81
7.1.1.1; Disseminating Existing Knowledge About CDSS;81
7.1.1.2; Clinical Workflow Integration;81
7.1.1.3; Keeping Abreast of New Clinical Research Developments;82
7.1.2;4.1.2 Technical Issues;82
7.1.2.1; Variety in Types of Data;82
7.1.2.2; Synthesizing Clinical Knowledge;83
7.2;4.2 Strategies to Improve the Usability of CDSS;83
7.2.1;4.2.1 Perform User-Centered Design;85
7.2.2;4.2.2 Create Approaches for Sharing CDS Knowledge, Modules and Services;86
7.2.3;4.2.3 Enhance Quality of Knowledge Base to Support Multimorbidity Decisions;87
7.2.4;4.2.4 Integrate CDSS with the EHR;88
7.2.5;4.2.5 Reduce Errors by Learning from Previous Experience;89
7.3;4.3 Safety-Enhanced Design and Usability Assessment;89
7.3.1;4.3.1 Safety-Enhanced Design (SED);90
7.3.2;4.3.2 Rapid Usability Assessment (RUA);90
7.3.3;4.3.3 Usability Testing;91
7.3.3.1; Card Sorting;92
7.3.3.2; Online Surveys;92
7.4;4.4 Summary;93
7.5;References;93
8;Chapter 5: Newer Architectures for Clinical Decision Support;97
8.1;5.1 Service-Oriented Architecture: Definition, Benefits, Challenges, History;98
8.2;5.2 Benefits and Challenges of SOA for Health IT Systems in General and CDSS in Particular;100
8.3;5.3 SOA Services and Capabilities Needed for CDS;102
8.4;5.4 Healthcare Services Specification Project;102
8.5;5.5 OpenCDS;103
8.6;5.6 CDS Consortium;103
8.7;5.7 Health eDecisions and Clinical Quality Framework;103
8.8;5.8 Healthcare Services Platform Consortium;104
8.9;5.9 Other Individual Efforts;104
8.10;5.10 Future Directions;105
8.11;5.11 Conclusions;105
8.12;References;105
9;Chapter 6: Best Practices for Implementation of Clinical Decision Support;108
9.1;6.1 Knowledge Synthesis;109
9.2;6.2 Knowledge Formalization;110
9.3;6.3 Knowledge Localization;112
9.3.1;6.3.1 Resource Constraints;113
9.3.2;6.3.2 Workflow;113
9.3.3;6.3.3 EHR Functionality;114
9.3.4;6.3.4 CDSS Design;114
9.3.5;6.3.5 CDS Modalities;115
9.3.6;6.3.6 Level of Enforcement;116
9.3.7;6.3.7 Participatory Design;116
9.4;6.4 Evaluation and Learning;116
9.5;6.5 Summary and Conclusions;117
9.6;References;117
10;Chapter 7: Impact of National Policies on the Use of Clinical Decision Support;119
10.1;7.1 United States Federal Government Clinical Decision Support Initiatives;120
10.2;7.2 Technical Foundations;121
10.3;7.3 Workflow and Knowledge Management;123
10.4;7.4 Health eDecisions and the Clinical Quality Framework;123
10.5;7.5 Clinical Decision Support and the HITECH Act;124
10.6;7.6 2015 CDS Certification Criteria;127
10.6.1;7.6.1 CDS Intervention Interaction;127
10.6.2;7.6.2 CDS Configuration;128
10.6.3;7.6.3 Evidence-Based Decision Support Interventions;128
10.6.4;7.6.4 Linked Referential CDS;129
10.6.5;7.6.5 Source Attributes;129
10.7;7.7 Implementation and Optimization Guidance;130
10.8;7.8 The Patient Protection and Affordable Care Act;130
10.9;7.9 Protecting Access to Medicare Act of 2014 (PAMA);130
10.10;7.10 Medicare Access and CHIP Reauthorization Act of 2015 (MACRA);132
10.11;7.11 Impact of Federal Programs on CDS;133
10.12;7.12 FDA Regulation of Clinical Decision Support;133
10.13;7.13 Clinical Decision Support for Immunizations (CDSi);134
10.14;7.14 Challenges;135
10.15;7.15 Future Initiatives;136
10.16;7.16 Summary and Conclusion;136
10.17;References;136
11;Chapter 8: Ethical and Legal Issues in Decision Support;139
11.1;8.1 Ethical Issues;140
11.1.1;8.1.1 Background and Current Research;140
11.1.2;8.1.2 Care Standards;141
11.1.3;8.1.3 Appropriate Use and Users;144
11.1.4;8.1.4 Professional Relationships;145
11.1.5;8.1.5 Decision Support in Genetics and Genomics;147
11.2;8.2 Regulation and the Law;148
11.2.1;8.2.1 Liability and Decision Support;148
11.2.2;8.2.2 Regulation of Clinical Decision Support Systems;150
11.3;8.3 Conclusion and Future Directions;152
11.4;References;152
12;Chapter 9: Evaluation of Clinical Decision Support;155
12.1;9.1 Strategies for CDSS Evaluation;156
12.2;9.2 Types of CDSS Evaluations;157
12.3;9.3 Types of Outcomes Assessed in CDSS Evaluations;158
12.4;9.4 Findings from Systematic Reviews of CDSS;158
12.5;9.5 Approach to Conducting an Evaluation of a CDSS;161
12.6;9.6 Challenges Associated with Evaluation of CDSS;165
12.7;9.7 Conclusions/Observations;167
12.8;References;168
13;Chapter 10: Decision Support for Patients;170
13.1;10.1 Introduction;170
13.2;10.2 Role of Consumer Health Informatics in Patient Care;171
13.2.1;10.2.1 Empowerment and Self-efficacy;172
13.2.2;10.2.2 Incorporating Patient Preferences;173
13.3;10.3 Interactive Tools for Patient Decision Support;174
13.3.1;10.3.1 Patient Decision Support for Diagnosis;174
13.3.2;10.3.2 Support for Patients’ Treatment Decisions;175
13.3.3;10.3.3 Other Areas of Decision Support for Patients;176
13.4;10.4 Usability of Patient Decision Support Tools;178
13.4.1;10.4.1 Intuitive Interface;178
13.4.2;10.4.2 Complete Coverage/Coordination;179
13.4.3;10.4.3 Hierarchical Presentation;179
13.4.4;10.4.4 Presentation of Materials Tailored to the Individual;179
13.4.5;10.4.5 Facilitate Quality Decision Making;179
13.5;10.5 Helping Patients Judge the Quality of Health Information;180
13.6;10.6 Patient Access, Literacy and Numeracy;181
13.7;10.7 The Future of Decision Support Systems for Patients;182
13.8;References;182
14;Chapter 11: Diagnostic Decision Support Systems;187
14.1;11.1 Definitions of Diagnosis;188
14.2;11.2 Human Diagnostic Reasoning;191
14.3;11.3 Historical Survey of Diagnostic Decision Support Systems;194
14.4;11.4 Developing, Implementing, Evaluating, and Maintaining Diagnostic Decision Support Systems;198
14.4.1;11.4.1 Clinical Domain Selection;199
14.4.2;11.4.2 Knowledge Base Construction and Maintenance;200
14.4.3;11.4.3 Diagnostic Algorithms and User Interfaces;201
14.4.4;11.4.4 Testing, Evaluation, and Quality Control;202
14.4.4.1; Appropriate Evaluation Design;202
14.4.4.2; Specification of Criteria for Determining Efficacy in the Evaluation;203
14.4.4.3; Evaluation of the Boundaries or Limitations;204
14.4.4.4; Identification of Potential Reasons for “Lack of System Effect”;204
14.4.5;11.4.5 Interface and Vocabulary Issues;205
14.4.6;11.4.6 Legal and Ethical Issues;206
14.5;11.5 Diagnostic Decision Support Systems Circa 2015;207
14.6;11.6 The Future of Diagnostic Decision Support Systems;208
14.7;References;210
15;Chapter 12: Use of Clinical Decision Support to Tailor Drug Therapy Based on Genomics;215
15.1;12.1 Opportunities for Integration of -Omic Technologies into CDSS;217
15.2;12.2 How Is Genomic Decision Support Different from Other Types of CDS?;217
15.3;12.3 State of the Evidence for Germline Pharmacogenomic Intervention;218
15.4;12.4 Who, What, and When to Test;221
15.5;12.5 Types of CDS Useful for Genomic Medicine;222
15.5.1;12.5.1 Passive Decision Support;222
15.5.2;12.5.2 Active Decision Support;223
15.5.3;12.5.3 Surveillance Decision Support Mechanisms;224
15.6;12.6 Standardized Representation of Genetic Variation;224
15.7;12.7 CDS Knowledge Bases;225
15.8;12.8 Examples of Genomic CDS in Practice;226
15.9;12.9 Direct-to-Consumer Genetic Testing;228
15.10;12.10 Conclusions;230
15.11;References;231
16;Chapter 13: Clinical Decision Support: The Experience at Brigham and Women’s Hospital/Partners HealthCare;233
16.1;13.1 Background;234
16.1.1;13.1.1 Brigham Integrated Computing System (BICS);234
16.1.2;13.1.2 Longitudinal Medical Record (LMR);236
16.2;13.2 Clinical Decision Support: Inpatient Applications and Assessment;236
16.2.1;13.2.1 Medication-Related Decision Support;236
16.2.1.1; General Applications;236
16.2.1.2; Reduction of Adverse Drug Events;238
16.2.1.3; Anticipatory Medication Decision Support;238
16.2.1.4; Medication-Specific Decision Support;239
16.2.2;13.2.2 Laboratory-Related Decision Support;239
16.2.2.1; Display of Charges at Test Ordering;239
16.2.2.2; Reduction in Redundant Testing;239
16.2.2.3; Tests Pending at Discharge;240
16.2.3;13.2.3 Radiology-Related Decision Support;241
16.2.3.1; Appropriateness of Ordered Studies;241
16.2.3.2; Notification About Critical Radiology Results;241
16.2.4;13.2.4 Transition of Care Support;242
16.2.5;13.2.5 Assessment of CPOE Impact on Users;242
16.3;13.3 Clinical Decision Support: Ambulatory Applications and Assessment;242
16.3.1;13.3.1 Ambulatory Medication Decision Support;242
16.3.2;13.3.2 Laboratory-Related Decision Support;243
16.3.3;13.3.3 Radiology-Related Decision Support;244
16.3.4;13.3.4 Clinical Reminders;244
16.3.5;13.3.5 Documentation-Related Decision Support;245
16.3.6;13.3.6 Problem-List Decision Support;245
16.3.7;13.3.7 Assessment of Ambulatory EHR Impact on Users;245
16.3.8;13.3.8 Patient-Centric Applications;245
16.4;13.4 Clinical Decision Support: Cost-Effectiveness;246
16.5;13.5 Overarching Lessons;246
16.6;13.6 Future Directions;247
16.7;References;247
17;Chapter 14: Clinical Decision Support at Intermountain Healthcare;251
17.1;14.1 The HELP System;254
17.2;14.2 Categories of Decision Support Technologies;256
17.3;14.3 Alerting Systems;256
17.3.1;14.3.1 Computerized Laboratory Alerting System;256
17.3.2;14.3.2 Unit-Wide Notification of Ventilator Disconnections;258
17.3.3;14.3.3 Early Prediction of Deterioration (ePOD);261
17.4;14.4 Critiquing Systems;262
17.4.1;14.4.1 Blood Product Order Critiquing;262
17.5;14.5 Suggestion Systems;264
17.5.1;14.5.1 Ventilator Management;264
17.6;14.6 Diagnostic Decision Support in the HELP System;266
17.7;14.7 Diagnostic Applications;267
17.7.1;14.7.1 Adverse Drug Events;267
17.7.2;14.7.2 Nosocomial Infections;269
17.8;14.8 Detecting Pneumonia in the Emergency Department;270
17.8.1;14.8.1 Antibiotic Assistant;271
17.9;14.9 Research into Complex Peri-diagnostic Applications;272
17.9.1;14.9.1 Assisting Data Collection;273
17.9.2;14.9.2 Assessing the Quality of Medical Reports;274
17.10;14.10 Summary;276
17.11;References;277
18;Chapter 15: Decision Support During Inpatient Care Provider Order Entry: Vanderbilt’s WizOrder Experience;281
18.1;15.1 Basic Care Provider Order Entry System Functionality;283
18.1.1;15.1.1 Creating Orders;285
18.1.2;15.1.2 Displaying Active Orders;287
18.1.3;15.1.3 Modifying and Finalizing Orders;288
18.1.4;15.1.4 Displaying Information and Providing Complex Decision Support;288
18.2;15.2 Philosophy Underlying Decision Support During Care Provider Order Entry;289
18.3;15.3 Roles for Decision Support Within Care Provider Order Entry: Categories of Interventions;292
18.3.1;15.3.1 Creating Legible, Complete, Correct, Rapidly Actionable Orders;292
18.3.2;15.3.2 Providing Patient-Specific Clinical Decision Support;292
18.3.3;15.3.3 Optimizing Clinical Care (Improved Workflow, More Cost-Effective and Regulatory-Compliant);292
18.3.4;15.3.4 Providing Just-in-Time, Focused Education Relevant to Patient Care;294
18.4;15.4 Critical Points at Which to Implement Decision Support Within Care Provider Order Entry;295
18.4.1;15.4.1 Stage of Care Provider Order Entry Session Initiation;295
18.4.2;15.4.2 Stage of Selecting Care Provider Order Entry Patient from Hospital Ward Census;295
18.4.3;15.4.3 Stage of Individual Patient Session Initiation;296
18.4.4;15.4.4 Stage of Individual (Single) Order Selection;299
18.4.5;15.4.5 Stage of Individual (Single) Order Construction;300
18.4.6;15.4.6 Stage of Individual Order Completion;300
18.4.7;15.4.7 Stage of Ordering Session Completion;302
18.5;15.5 Care Provider Order Entry Intervention Approaches: From Subtle to Intrusive;305
18.5.1;15.5.1 Incidental Display of Relevant Information;305
18.5.2;15.5.2 Incidental Display of Linked Educational Opportunities;305
18.5.3;15.5.3 Interactive Sequential Advice for User-Directed Clinical Activity;306
18.5.4;15.5.4 Recallable Best Practice Guidelines with Actionable Pre-formed Pick List Selections;307
18.5.5;15.5.5 Pop-Up Alerts That Interrupt Workflow and Require a Response for the User to Continue;307
18.5.6;15.5.6 Complex, Computer-Based Protocols That Interact with the User to Make Patient-Specific Calculations and Recommendations;307
18.6;15.6 CPOE Systems Circa 2015;310
18.7;15.7 Conclusion;311
18.8;References;311
19;Index;317