Liaw Siaw-Teng, Sulaiman Nabil, Pearce Christopher, Sims Jane, Hill Keith, Grain Heather, Tse Justin, Ng Choon-Kiat
MBBS, Department of General Practice, The University of Melbourne, 200 Berkeley Street, Carlton, VIC 3053, Australia.
J Am Med Inform Assoc. 2003 Sep-Oct;10(5):425-32. doi: 10.1197/jamia.M1281. Epub 2003 Jun 4.
The iterative development of the Falls Risk Assessment and Management System (FRAMS) drew upon research evidence and early consumer and clinician input through focus groups, interviews, direct observations, and an online questionnaire. Clinical vignettes were used to validate the clinical model and program logic, input, and output. The information model was developed within the Australian General Practice Data Model (GPDM) framework. The online FRAMS implementation used available Internet (TCP/IP), messaging (HL7, XML), knowledge representation (Arden Syntax), and classification (ICD10-AM, ICPC2) standards. Although it could accommodate most of the falls prevention information elements, the GPDM required extension for prevention and prescribing risk management. Existing classifications could not classify all falls prevention concepts. The lack of explicit rules for terminology and data definitions allowed multiple concept representations across the terminology-architecture interface. Patients were more enthusiastic than clinicians. A usable standards-based online-distributed decision support system for falls prevention can be implemented within the GPDM, but a comprehensive terminology is required. The conceptual interface between terminology and architecture requires standardization, preferably within a reference information model. Developments in electronic decision support must be guided by evidence-based clinical and information models and knowledge ontologies. The safety and quality of knowledge-based decision support systems must be monitored. Further examination of falls and other clinical domains within the GPDM is needed.
跌倒风险评估与管理系统（FRAMS）的迭代开发借鉴了研究证据以及早期通过焦点小组、访谈、直接观察和在线问卷收集的消费者与临床医生的意见。临床案例用于验证临床模型、程序逻辑、输入和输出。信息模型是在澳大利亚全科医疗数据模型（GPDM）框架内开发的。在线FRAMS实施采用了现有的互联网（TCP/IP）、消息传递（HL7、XML）、知识表示（Arden语法）和分类（ICD10 - AM、ICPC2）标准。尽管GPDM能够容纳大多数跌倒预防信息元素，但在预防和处方风险管理方面需要扩展。现有的分类无法对所有跌倒预防概念进行分类。术语和数据定义缺乏明确规则，导致在术语 - 架构接口处存在多种概念表示形式。患者比临床医生更热情。可以在GPDM内实施一个基于标准的、可用的在线分布式跌倒预防决策支持系统，但需要一个全面的术语表。术语和架构之间的概念接口需要标准化，最好在参考信息模型内进行。电子决策支持的发展必须以基于证据的临床和信息模型以及知识本体为指导。基于知识的决策支持系统的安全性和质量必须受到监控。需要对GPDM内的跌倒及其他临床领域进行进一步研究。
