临床决策支持架构演变的四阶段模型。
A four-phase model of the evolution of clinical decision support architectures.
作者信息
Wright Adam, Sittig Dean F
机构信息
Clinical Informatics Research and Development, Partners HealthCare, Boston, MA 02120, USA.
出版信息
Int J Med Inform. 2008 Oct;77(10):641-9. doi: 10.1016/j.ijmedinf.2008.01.004. Epub 2008 Mar 19.
BACKGROUND
A large body of evidence over many years suggests that clinical decision support systems can be helpful in improving both clinical outcomes and adherence to evidence-based guidelines. However, to this day, clinical decision support systems are not widely used outside of a small number of sites. One reason why decision support systems are not widely used is the relative difficulty of integrating such systems into clinical workflows and computer systems.
PURPOSE
To review and synthesize the history of clinical decision support systems, and to propose a model of various architectures for integrating clinical decision support systems with clinical systems.
METHODS
The authors conducted an extensive review of the clinical decision support literature since 1959, sequenced the systems and developed a model.
RESULTS
The model developed consists of four phases: standalone decision support systems, decision support integrated into clinical systems, standards for sharing clinical decision support content and service models for decision support. These four phases have not heretofore been identified, but they track remarkably well with the chronological history of clinical decision support, and show evolving and increasingly sophisticated attempts to ease integrating decision support systems into clinical workflows and other clinical systems.
CONCLUSIONS
Each of the four evolutionary approaches to decision support architecture has unique advantages and disadvantages. A key lesson was that there were common limitations that almost all the approaches faced, and no single approach has been able to entirely surmount: (1) fixed knowledge representation systems inherently circumscribe the type of knowledge that can be represented in them, (2) there are serious terminological issues, (3) patient data may be spread across several sources with no single source having a complete view of the patient, and (4) major difficulties exist in transferring successful interventions from one site to another.
背景
多年来大量证据表明，临床决策支持系统有助于改善临床结果并提高对循证指南的依从性。然而，时至今日，临床决策支持系统在少数机构之外并未得到广泛应用。决策支持系统未被广泛使用的一个原因是将此类系统集成到临床工作流程和计算机系统中相对困难。
目的
回顾并综合临床决策支持系统的历史，并提出将临床决策支持系统与临床系统集成的各种架构模型。
方法
作者对1959年以来的临床决策支持文献进行了广泛回顾，梳理了这些系统并开发了一个模型。
结果
所开发的模型包括四个阶段：独立决策支持系统、集成到临床系统中的决策支持、共享临床决策支持内容的标准以及决策支持的服务模式。此前尚未识别出这四个阶段，但它们与临床决策支持的时间顺序历史非常吻合，并显示出为便于将决策支持系统集成到临床工作流程和其他临床系统中而进行的不断演变且日益复杂的尝试。
结论
决策支持架构的四种演进方法各有独特的优缺点。一个关键教训是，几乎所有方法都面临共同的局限性，没有一种方法能够完全克服：（1）固定的知识表示系统本质上限制了其中可以表示的知识类型；（2）存在严重的术语问题；（3）患者数据可能分散在多个来源，没有一个单一来源能全面了解患者情况；（4）将成功的干预措施从一个机构转移到另一个机构存在重大困难。
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