Clinical Decision Support Systems
Dimitar Hristovski, Ph.D. E-mail: dimitar.hristovski@mf.uni-lj.si
Institute of Biomedical Informatics Medical Faculty University of Ljubljana, Slovenia
Definition
A medical decision-support system is any computer program designed to help health professionals make clinical decisions. In a sense, any computer system that deals with clinical data or medical knowledge is intended to provide decision support. Three types of decision-support function, ranging from generalized to patient specific.
Alpe Adria Master Course :: Medical Informatics :: Dr. D. Hristovski: Clinical Decision Support Systems
Tools for Information Management
Examples:
Hospital information systems Bibliographic retrieval systems (PubMed) Specialized knowledge-management workstations (e.g. electronic textbooks, …)
These tools provide the data and knowledge needed, but they do not help to apply that information to a particular decision task (particular patient)
Alpe Adria Master Course :: Medical Informatics :: Dr. D. Hristovski: Clinical Decision Support Systems
Tools for Focusing Attention
Examples:
Clinical laboratory systems that flag abnormal values or that provide lists of possible explanations for those abnormalities. Pharmacy systems that alert providers to possible drug interactions or incorrect drug dosages
Are designed to remind the physician of diagnoses or problems that might be overlooked.
Alpe Adria Master Course :: Medical Informatics :: Dr. D. Hristovski: Clinical Decision Support Systems
Tools for Patient-Specific Consultation
Provide customized assessments or advice based on sets of patient-specific data:
Suggest differential diagnoses Advice about additional tests and examinations Treatment advice (therapy, surgery, …)
Alpe Adria Master Course :: Medical Informatics :: Dr. D. Hristovski: Clinical Decision Support Systems
Alternative (more specific) Definition
Clinical decision support systems are active knowledge systems which use two or more items of patient data to generate casespecific advice. Main components:
Medical knowledge Patient data Case-specific advice
Alpe Adria Master Course :: Medical Informatics :: Dr. D. Hristovski: Clinical Decision Support Systems
Characterizing Decision-Support Systems along Five Dimensions
System function
Determining what is true about a patient (e.g. correct diagnosis) Determining what to do (what test to order, to treat or not, what therapy plan …)
The mode for giving advice
Passive role (physician uses the system when advice needed) Active role (the system gives advice automatically under certain conditions)
Alpe Adria Master Course :: Medical Informatics :: Dr. D. Hristovski: Clinical Decision Support Systems
Passive Systems
The user has total control:
Requires advice Analyses the advice Accepts/Rejects the advice Wide domain like internal medicine
Domain of use:
Examples: QMR, DXPLAIN Acute abdominal pain Analysis of ECG
Narrow domain
Alpe Adria Master Course :: Medical Informatics :: Dr. D. Hristovski: Clinical Decision Support Systems
Passive Systems (cont.)
Characteristics:
Stand-alone Data entry:
System initiative User initiative
Consulting model Critiquing model
Consultation style
Alpe Adria Master Course :: Medical Informatics :: Dr. D. Hristovski: Clinical Decision Support Systems
Active Systems
The user has partial control
System gives advice User evaluates the advice The user accepts/rejects the advice Limited domain
Domain of use
Drug interactions Protocol conformance control Laboratory results warnings Medical devices control
Alpe Adria Master Course :: Medical Informatics :: Dr. D. Hristovski: Clinical Decision Support Systems
Active Systems (cont.)
Characteristics
Built-in/integrated with other system (e.g. laboratory information system, or pharmacy system)
Data entry
By the user Related to the main application
Critiquing model HELP (advices and reminders, therapy) CARE (reminders)
Consultation style
Examples:
Alpe Adria Master Course :: Medical Informatics :: Dr. D. Hristovski: Clinical Decision Support Systems
Consultation style
The system operates under consulting model The system operates under critiquing model
ATTENDING (anesthesia) HELP ONCOCIN (oncology, therapy plan)
Alpe Adria Master Course :: Medical Informatics :: Dr. D. Hristovski: Clinical Decision Support Systems
Underlying Decision-Science Methodology
Problem-specific algorithms Pattern recognition Statistical methods (Bayesian statistics, decision analysis, …) Artificial intelligence (knowledge-based systems)
Expert systems (MYCIN – therapy selection for patients with bacteremia or meningitis) Machine learning Neural networks
Decision trees Decision rules
Knowledge representation formalisms:
Alpe Adria Master Course :: Medical Informatics :: Dr. D. Hristovski: Clinical Decision Support Systems
Example: Decision Tree 1
Alpe Adria Master Course :: Medical Informatics :: Dr. D. Hristovski: Clinical Decision Support Systems
Example: Decision Tree 2
Alpe Adria Master Course :: Medical Informatics :: Dr. D. Hristovski: Clinical Decision Support Systems
Example: Decision Rule 1
Alpe Adria Master Course :: Medical Informatics :: Dr. D. Hristovski: Clinical Decision Support Systems
System MYCIN – a Decision Rule
Alpe Adria Master Course :: Medical Informatics :: Dr. D. Hristovski: Clinical Decision Support Systems
System MYCIN – Explanation Example
Alpe Adria Master Course :: Medical Informatics :: Dr. D. Hristovski: Clinical Decision Support Systems
System HELP – MLM Example (Medical Logic Module)
Alpe Adria Master Course :: Medical Informatics :: Dr. D. Hristovski: Clinical Decision Support Systems
System ONCOCIN – Cancer-Treatment Protocol Example
Alpe Adria Master Course :: Medical Informatics :: Dr. D. Hristovski: Clinical Decision Support Systems
Human factors
Logistics User interface Psychology of human-computer interaction
Legal and regulatory questions Integration
Stand-alone systems have no future Data have to be entered only once Advice integrated in the basic information system (e.g. electronic medical record)
Alpe Adria Master Course :: Medical Informatics :: Dr. D. Hristovski: Clinical Decision Support Systems
General Architecture of a Knowledge-Based Clinical Decision Support System
Knowledge base Data Entry
Inference Mechanism
diagnosis explanations questions
User
Patient
Therapy
Alpe Adria Master Course :: Medical Informatics :: Dr. D. Hristovski: Clinical Decision Support Systems
Characteristics of modern knowledgebased decision support systems:
The used medical knowledge (knowledge base) separated from the mechanisms using that knowledge (inference mechanisms)
Medical knowledge acquisition:
Experts Medical literature Automatically from medical data (induction, machine learning)
Alpe Adria Master Course :: Medical Informatics :: Dr. D. Hristovski: Clinical Decision Support Systems
Example: DXplain
Can be accessed at: http://www.mf.uni-lj.si/cmk
Alpe Adria Master Course :: Medical Informatics :: Dr. D. Hristovski: Clinical Decision Support Systems
Alpe Adria Master Course :: Medical Informatics :: Dr. D. Hristovski: Clinical Decision Support Systems
Alpe Adria Master Course :: Medical Informatics :: Dr. D. Hristovski: Clinical Decision Support Systems
Alpe Adria Master Course :: Medical Informatics :: Dr. D. Hristovski: Clinical Decision Support Systems
Alpe Adria Master Course :: Medical Informatics :: Dr. D. Hristovski: Clinical Decision Support Systems
Alpe Adria Master Course :: Medical Informatics :: Dr. D. Hristovski: Clinical Decision Support Systems
Disease Information
Alpe Adria Master Course :: Medical Informatics :: Dr. D. Hristovski: Clinical Decision Support Systems
Symptom Information
Alpe Adria Master Course :: Medical Informatics :: Dr. D. Hristovski: Clinical Decision Support Systems
Alpe Adria Master Course :: Medical Informatics :: Dr. D. Hristovski: Clinical Decision Support Systems
Alpe Adria Master Course :: Medical Informatics :: Dr. D. Hristovski: Clinical Decision Support Systems
Alpe Adria Master Course :: Medical Informatics :: Dr. D. Hristovski: Clinical Decision Support Systems
Alpe Adria Master Course :: Medical Informatics :: Dr. D. Hristovski: Clinical Decision Support Systems
Alpe Adria Master Course :: Medical Informatics :: Dr. D. Hristovski: Clinical Decision Support Systems