Clinical Informatics Research and Development, Partners HealthCare, 93 Worcester Street, 2nd floor, Wellesley, MA 02481, USA.
BMC Med Inform Decis Mak. 2012 Nov 12;12:128. doi: 10.1186/1472-6947-12-128.
Efficient rule authoring tools are critical to allow clinical Knowledge Engineers (KEs), Software Engineers (SEs), and Subject Matter Experts (SMEs) to convert medical knowledge into machine executable clinical decision support rules. The goal of this analysis was to identify the critical success factors and challenges of a fully functioning Rule Authoring Environment (RAE) in order to define requirements for a scalable, comprehensive tool to manage enterprise level rules.
The authors evaluated RAEs in active use across Partners Healthcare, including enterprise wide, ambulatory only, and system specific tools, with a focus on rule editors for reminder and medication rules. We conducted meetings with users of these RAEs to discuss their general experience and perceived advantages and limitations of these tools.
While the overall rule authoring process is similar across the 10 separate RAEs, the system capabilities and architecture vary widely. Most current RAEs limit the ability of the clinical decision support (CDS) interventions to be standardized, sharable, interoperable, and extensible. No existing system meets all requirements defined by knowledge management users.
A successful, scalable, integrated rule authoring environment will need to support a number of key requirements and functions in the areas of knowledge representation, metadata, terminology, authoring collaboration, user interface, integration with electronic health record (EHR) systems, testing, and reporting.
高效的规则创作工具对于将医学知识转化为可执行的临床决策支持规则至关重要,这需要临床知识工程师(KE)、软件工程师(SE)和主题专家(SME)来完成。本分析旨在确定功能齐全的规则创作环境(RAE)的关键成功因素和挑战,以便为管理企业级规则的可扩展、全面工具定义需求。
作者评估了 Partners Healthcare 中正在使用的各种 RAE,包括全企业范围、仅门诊和特定于系统的工具,重点关注提醒和药物规则的规则编辑器。我们与这些 RAE 的用户进行了会议,讨论了他们对这些工具的一般体验以及对这些工具的优势和局限性的看法。
虽然这 10 个独立的 RAE 的整体规则创作过程相似,但系统功能和架构却大不相同。大多数当前的 RAE 限制了临床决策支持(CDS)干预措施的标准化、可共享性、互操作性和可扩展性。没有现有的系统能够满足知识管理用户定义的所有要求。
一个成功的、可扩展的、集成的规则创作环境需要在知识表示、元数据、术语、创作协作、用户界面、与电子健康记录(EHR)系统的集成、测试和报告等领域支持许多关键要求和功能。