Kaplan B
Center for Medical Informatics, Yale University School of Medicine, New Haven, CT, USA.
Int J Med Inform. 2001 Nov;64(1):15-37. doi: 10.1016/s1386-5056(01)00183-6.
This paper reviews clinical decision support systems (CDSS) literature, with a focus on evaluation. The literature indicates a general consensus that clinical decision support systems are thought to have the potential to improve care. Evidence is more equivocal for guidelines and for systems to aid physicians with diagnosis. There also is general consensus that a variety of systems are little used despite demonstrated or potential benefits. In the evaluation literature, the main emphasis is on how clinical performance changes. Most studies use an experimental or randomized controlled clinical trials design (RCT) to assess system performance or to focus on changes in clinical performance that could affect patient care. Few studies involve field tests of a CDSS and almost none use a naturalistic design in routine clinical settings with real patients. In addition, there is little theoretical discussion, although papers are permeated by a rationalist perspective that excludes contextual issues related to how and why systems are used. The studies mostly concern physicians rather than other clinicians. Further, CDSS evaluation studies appear to be insulated from evaluations of other informatics applications. Consequently, there is a lack of information useful for understanding why CDSSs may or may not be effective, resulting in making less informed decisions about these technologies and, by extension, other medical informatics applications.
本文回顾了临床决策支持系统（CDSS）的相关文献，重点在于评估。文献表明，人们普遍认为临床决策支持系统有改善医疗护理的潜力。对于指南以及辅助医生诊断的系统，证据则较为模糊。同样存在普遍共识的是，尽管有已证实的或潜在的益处，但各种系统的使用却很少。在评估文献中，主要重点在于临床性能如何变化。大多数研究采用实验性或随机对照临床试验设计（RCT）来评估系统性能，或者关注可能影响患者护理的临床性能变化。很少有研究涉及CDSS的实地测试，几乎没有研究在有真实患者的常规临床环境中采用自然主义设计。此外，尽管论文中充斥着一种排除了与系统使用方式及原因相关的背景问题的理性主义观点，但理论讨论却很少。这些研究大多关注医生而非其他临床医生。此外，CDSS评估研究似乎与其他信息学应用的评估相互隔离。因此，缺乏有助于理解CDSS为何可能有效或无效的信息，导致在对这些技术以及由此延伸的其他医学信息学应用做出决策时缺乏充分的信息依据。
