Clinical Decision Support - 1st Edition - ISBN: 9780123693778, 9780080467696

Clinical Decision Support

1st Edition

The Road Ahead

Editors: Robert Greenes
eBook ISBN: 9780080467696
Hardcover ISBN: 9780123693778
Imprint: Academic Press
Published Date: 30th November 2006
Page Count: 544
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Description

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.

Readership

Health care professionals, medical informatics researchers and students, policy makers, IT development managers, and various clinical investigators

Table of Contents

Contributors

Preface

I: Computer-based clinical decision support: Concepts and origins

Chapter 1: Definition, scope, and challenges

1.1 INTRODUCTION

1.2 DEFINITION OF COMPUTER-BASED CLINICAL DECISION SUPPORT

1.3 FEATURES OF CDS

1.4 THE TALE OF A RELATIONSHIP

1.5 SCOPE AND PLAN OF THIS BOOK

REFERENCES

Chapter 2: A Brief history of clinical decision support

2.1 PRIMARY RESEARCH METHODOLOGIES THAT HAVE BEEN PURSUED AND EXTENDED

2.2 DRIVING FORCES FOR CDS

2.3 CONCLUSION

REFERENCES

Chapter 3: Features of computer-based clinical decision support

3.1 CDS AND THE HUMAN

3.2 DESIGN AND STRUCTURE OF CDS

3.3 OTHER CONSIDERATIONS

REFERENCES

II: Case studies and current status

Chapter 4: Regenstrief medical informatics

4.1 INTRODUCTION

4.2 HISTORY

4.3 CONCLUSION

REFERENCES

Chapter 5: Patients, doctors, and information technology

5.1 HISTORY

5.2 CLINICAL DECISION SUPPORT AND INPATIENT CPOE AT BWH

5.3 DECISION SUPPORT DELIVERED USING THE OUTPATIENT ELECTRONIC HEALTH RECORD

5.4 OVERARCHING STUDIES

5.5 OVERARCHING LESSONS

5.6 FUTURE DIRECTIONS

REFERENCES

Chapter 6: Case studies in clinical decision support

6.1 INTRODUCTION

6.2 TOOLS FOR INFORMATION MANAGEMENT

6.3 TOOLS FOR FOCUSING ATTENTION

6.4 TOOLS FOR PATIENT-SPECIFIC CONSULTATION

6.5 CONCLUSION

REFERENCES

Chapter 7: Penetration and availability of clinical decision support in commercial systems

7.1 INTRODUCTION

7.2 CDS PENETRATION AND AVAILABILITY IN COMMERCIAL SYSTEMS

7.3 CLINICAL ALERTING IN 2002

7.4 OBSTACLES TO CDS IN 2002

7.5 WHAT CHANGED SINCE EARLY 2002?

7.6 HOW FAR ALONG ARE CDS VENDORS IN 2005?

7.7 SELF-REPORTED VENDOR DATA AS OF FEBRUARY 2005

7.8 CONCLUSION

REFERENCES

VENDOR WEB SITE REFERENCES

Chapter 8: Lessons learned

8.1 ACADEMIC PROTOTYPES

8.2 STANDARDS AND SHARING OF INTEROPERABLE CONTENT AND TOOLS

8.3 USERS

8.4 OTHER CONSIDERATIONS

REFERENCES

III: Generation and formulation of knowledge

Chapter 9: Human-Intensive techniques

9.1 INTRODUCTION

9.2 THEORETICAL BASIS FOR KNOWLEDGE ACQUISITION

9.3 COGNITIVE TASK ANALYSIS

9.4 COMPUTER-BASED KNOWLEDGE ACQUISITION

9.5 CONCLUSION

REFERENCES

Chapter 10: Generation of knowledge for clinical decision support

10.1 INTRODUCTION

10.2 LEARNING FROM DATA

10.3 OVERVIEW OF LOGISTIC REGRESSION

10.4 OVERVIEW OF SOME MACHINE LEARNING MODELS

10.5 PREDICTION MODELS IN MEDICINE

10.6 CONCLUSION

REFERENCES

Chapter 11: Evidence-based medicine and meta-analysis

11.1 SYSTEMATIC REVIEWS AND META-ANALYSES

11.2 METHODOLOGIES OF SYSTEMATIC REVIEW AND META-ANALYSIS

11.3 DEVELOPING A SYSTEMATIC REVIEW PROTOCOL

11.4 FORMULATING THE RESEARCH QUESTION

11.5 LITERATURE SEARCH

11.6 DATA EXTRACTION

11.7 ASSESSING THE QUALITY OF STUDIES

11.8 COMBINING DATA IN A META-ANALYSIS

11.9 EXPLORING HETEROGENEITY WITH SUBGROUP AND META-REGRESSION ANALYSES

11.10 ISSUES IN CONDUCTING META-ANALYSES

11.11 USES OF SYSTEMATIC REVIEWS AND META-ANALYSES

11.12 ACCESSING SYSTEMATIC REVIEWS AND META-ANALYSES AND RELATED PRODUCTS

11.13 CONCLUSION

REFERENCES

IV: Representing the knowledge

Chapter 12: Decision rules and expressions

12.1 INTRODUCTION

12.2 PROCEDURAL KNOWLEDGE

12.3 KNOWLEDGE AS PRODUCTION RULES

12.4 THE HYBRID APPROACH: ARDEN SYNTAX

12.5 EXPRESSION LANGUAGES

12.6 FUTURE WORK

12.7 CONCLUSION

REFERENCES

Chapter 13: Guidelines and workflow models

13.1 INTRODUCTION: CLINICAL GUIDELINES AND ALGORITHMS

13.2 THE KNOWLEDGE CONTAINED IN CLINICAL GUIDELINES

13.3 FORMAL METHODS FOR SPECIFYING CIGS

13.4 FROM NARRATIVE TO FORMAL REPRESENTATIONS OF GUIDELINES

13.5 INTEGRATION OF GUIDELINES WITH WORKFLOW

13.6 METHODS FOR SHARING OF CIG CONTENT

13.7 CONCLUSION

13.8 RECOMMENDED RESOURCES

ACKNOWLEDGMENTS

REFERENCES

Chapter 14: Ontologies, vocabularies, and data models

14.1 INTRODUCTION

14.2 THE NEED FOR CODED DATA

14.3 REFERENCING DATA IN DECISION LOGIC

14.4 ISSUES OF PRE- AND POSTCOORDINATION

14.5 DATA REPRESENTATION USING NAME-VALUE PAIRS

14.6 TERMINOLOGY IN THE LIFE CYCLE OF DECISION SUPPORT PROGRAMS

14.7 CONTEXTUAL RESTRICTIONS WITHIN THE TERMINOLOGY

14.8 WHAT NEEDS TO BE DONE

REFERENCES

Chapter 15: Grouped knowledge elements

15.1 INTRODUCTION

15.2 CLINICAL DOCUMENTATION

15.3 CURRENT APPROACHES TO CLINICAL DOCUMENTATION

15.4 GROUPED KNOWLEDGE ELEMENTS (KEGs)

15.5 CONCLUSION

REFERENCES

Chapter 16: Infobuttons and point of care access to knowledge

16.1 INTRODUCTION

16.2 UNDERSTANDING AND ADDRESSING CLINICIAN INFORMATION NEEDS

16.3 LINKING CLINICAL INFORMATION SYSTEMS TO ONLINE RESOURCES

16.4 INFOBUTTONS

16.5 MANAGING INFOBUTTONS

16.6 INFOBUTTON STANDARDIZATION

16.7 STANDARDS FOR INFORMATION RESOURCES

16.8 CONCLUSION

RECOMMENDED RESOURCES

ACKNOWLEDGMENTS

REFERENCES

Chapter 17: The role of standards

17.1 KEY STANDARDS AND THEIR BENEFITS

17.2 HOW IMPORTANT ARE STANDARDS?

REFERENCES

V: Organizational, business, and social challenges

Chapter 18: Organizational and cultural change considerations

18.1 INTRODUCTION

18.2 ORGANIZATIONAL ISSUES RELATED TO CLINICAL DECISION SUPPORT

18.3 PLANNING WITH THESE ISSUES IN MIND

18.4 DEVELOPMENT, IMPLEMENTATION, AND MODIFICATION

18.5 EVALUATION AND MAINTENANCE

18.6 CONCLUSION

RESOURCES

ACKNOWLEDGMENTS

REFERENCES

Chapter 19: Managing the investment in clinical decision support

19.1 INTRODUCTION

19.2 KNOWLEDGE MANAGEMENT

19.3 ORGANIZATION OF THE EFFORT

19.4 KEY IT STRATEGIES AND CONSIDERATIONS

19.5 EVALUATION OF THE IMPACT AND VALUE OF KNOWLEDGE MANAGEMENT

19.6 CONCLUSION

REFERENCES

Chapter 20: Legal and regulatory issues related to the use of clinical software in health care delivery

20.1 INTRODUCTION

20.2 LEGAL ISSUES RELATED TO USING EMBEDDED AND FREE-STANDING DECISION SUPPORT SOFTWARE IN CLINICAL SETTINGS

20.3 RESPONSIBILITY FOR CDS SOFTWARE AT THE INSTITUTIONAL LEVEL AND POTENTIAL GOVERNMENTAL REGULATION

20.4 CONCLUSION

ACKNOWLEDGMENTS

REFERENCES

VI: Knowledge management approaches

Chapter 21: Knowledge management infrastructure

21.1 INTRODUCTION

21.2 RAPID INNOVATION DISCOVERY AND ADOPTION: KEY INFRASTRUCTURE REQUIREMENTS

21.3 KNOWLEDGE ASSET MANAGEMENT INFRASTRUCTURE

21.4 CONCLUSION

REFERENCES

Chapter 22: The clinical knowledge management infrastructure of intermountain healthcare

22.1 CLINICAL KNOWLEDGE MANAGEMENT AT INTERMOUNTAIN HEALTHCARE

22.2 KNOWLEDGE ASSETS

22.3 SOFTWARE INFRASTRUCTURE

ACKNOWLEDGMENTS

REFERENCES

Chapter 23: Integration of knowledge resources into applications to enable clinical decision support

23.1 INTRODUCTION

23.2 TERM DEFINITIONS

23.3 KNOWLEDGE INTEGRATION TASKS

23.4 ARCHITECTURAL CONSIDERATIONS

23.5 CASE STUDIES

23.6 LESSONS LEARNED FROM MARKET ADOPTION PATTERNS

23.7 PROPOSAL FOR A SOA APPROACH TO CLINICAL DECISION SUPPORT

23.8 CONCLUSION

RECOMMENDED RESOURCES

ACKNOWLEDGMENTS

REFERENCES

VII: The road ahead

Chapter 24: A proposed strategy for overcoming inertia

24.1 EXISTING APPROACHES NOT WORKING

24.2 NEED FOR NEW MECHANISMS

24.3 RATIONALE FOR COMMUNAL INFRASTRUCTURE, RESOURCES, AND TOOLS

24.4 ORGANIZATION OF PROCESS

24.5 OVERVIEW OF STRATEGY

24.6 IDENTIFYING KEY SOCIETAL DRIVERS AND SETTING PRIORITIES

24.7 FORMALIZING THE THREE LIFE CYCLE PROCESSES

24.8 GETTING SPECIFIC: END-TO-END IMPLEMENTATION STARTING WITH HIGH-PRIORITY FOCUS AREA(s)

24.9 LOOKING AHEAD: EPILOGUE AS PROLOGUE

REFERENCES

Index

Details

No. of pages:
544
Language:
English
Copyright:
© Academic Press 2007
Published:
Imprint:
Academic Press
eBook ISBN:
9780080467696
Hardcover ISBN:
9780123693778

About the Editor

Robert Greenes

Affiliations and Expertise

Arizona State University and Mayo Clinic, Phoenix, AZ, USA