Coiera E, Lau A Y S, Tsafnat G, Sintchenko V, Magrabi F
Centre for Health Informatics, University of New South Wales, UNSW 2052 NSW Australia.
Yearb Med Inform. 2009:84-95.
To review the recent research literature in clinical decision support systems (CDSS).
A review of recent literature was undertaken, focussing on CDSS evaluation, consumers and public health, the impact of translational bioinformatics on CDSS design, and CDSS safety.
In recent years, researchers have concentrated much less on the development of decision technologies, and have focussed more on the impact of CDSS in the clinical world. Recent work highlights that traditional process measures of CDSS effectiveness, such as document relevance are poor proxy measures for decision outcomes. Measuring the dynamics of decision making, for example via decision velocity, may produce a more accurate picture of effectiveness. Another trend is the broadening of user base for CDSS beyond front line clinicians. Consumers are now a major focus for biomedical informatics, as are public health officials, tasked with detecting and managing disease outbreaks at a health system, rather than individual patient level. Bioinformatics is also changing the nature of CDSS. Apart from personalisation of therapy recommendations, translational bioinformatics is creating new challenges in the interpretation of the meaning of genetic data. Finally, there is much recent interest in the safety and effectiveness of computerised physician order entry (CPOE) systems, given that prescribing and administration errors are a significant cause of morbidity and mortality. Of note, there is still much controversy surrounding the contention that poorly designed, implemented or used CDSS may actually lead to harm.
CDSS research remains an active and evolving area of research, as CDSS penetrate more widely beyond their traditional domain into consumer decision support, and as decisions become more complex, for example by involving sequence level genetic data.
回顾临床决策支持系统（CDSS）的近期研究文献。
对近期文献进行综述，重点关注CDSS评估、消费者与公共卫生、转化生物信息学对CDSS设计的影响以及CDSS安全性。
近年来，研究人员对决策技术开发的关注大幅减少，而更多地聚焦于CDSS在临床领域的影响。近期研究表明，传统的CDSS有效性过程指标，如文档相关性，对于决策结果而言是较差的替代指标。通过决策速度等方式衡量决策动态，可能会更准确地反映有效性。另一个趋势是CDSS的用户群体从一线临床医生扩展到了其他人群。消费者如今成为生物医学信息学的主要关注对象，公共卫生官员也是如此，他们负责在卫生系统层面而非个体患者层面检测和管理疾病爆发。生物信息学也在改变CDSS的性质。除了治疗建议的个性化之外，转化生物信息学在解读基因数据的意义方面带来了新的挑战。最后，鉴于处方和给药错误是发病和死亡的重要原因，近期人们对计算机化医生医嘱录入（CPOE）系统的安全性和有效性兴趣浓厚。值得注意的是，对于设计、实施或使用不当的CDSS可能实际上会导致伤害这一观点，仍存在诸多争议。
随着CDSS更广泛地渗透到传统领域之外，进入消费者决策支持领域，并且决策变得更加复杂，例如涉及序列水平的基因数据，CDSS研究仍然是一个活跃且不断发展的研究领域。
