Gardner Reed M
Department of Medical Informatics, University of Utah School of Medicine, Room AB 193 SOM, 30 North 1900 East, Salt Lake City UT 84132-2913, USA.
Respir Care. 2004 Apr;49(4):378-86; discussion 386-8.
Computers were initially used in health care for billing and administrative functions. More recently computers have been used to present clinical information such as laboratory results and pharmacy orders. Many medical informatics researchers believe that the ultimate goal of the "electronic health record" should be to advance computerized clinical decision-support. This report considers the challenges of developing electronic-health-record systems and integrating them into useful computerized decision-support systems and presents a "pyramid of progress" concept that involves 5 steps: (1) to gather electronic health data into a standardized and coded format, (2) to validate the quality of that electronic health data, (3) to optimize presentation of electronic health data and explore computerized decision-support, (4) to develop and share computerized knowledge bases that are based on clinical evidence as well as consensus, and (5) to tailor and to implement the computerized strategies so that they fit into the workflow process of patient care. This report discusses 3 examples of successful computerized clinical decision-support (use of antibiotics, laboratory alerting, and ventilator management) and discusses strategies essential to making computerized clinical decision-support more widely available and useful.
计算机最初在医疗保健领域用于计费和行政职能。最近，计算机已被用于呈现临床信息，如实验室检查结果和药房医嘱。许多医学信息学研究人员认为，“电子健康记录”的最终目标应该是推进计算机化临床决策支持。本报告考虑了开发电子健康记录系统并将其整合到有用的计算机化决策支持系统所面临的挑战，并提出了一个“进步金字塔”概念，该概念涉及5个步骤：（1）将电子健康数据收集成标准化和编码格式；（2）验证该电子健康数据的质量；（3）优化电子健康数据的呈现并探索计算机化决策支持；（4）开发并共享基于临床证据以及共识的计算机化知识库；（5）定制并实施计算机化策略，使其适应患者护理的工作流程。本报告讨论了3个成功的计算机化临床决策支持的例子（抗生素的使用、实验室警报和呼吸机管理），并讨论了使计算机化临床决策支持更广泛可用且更有用所必需的策略。
