de Dombal F T
Clinical Information Science Unit, University of Leeds, U.K.
Int J Biomed Comput. 1989 Mar;24(1):9-16. doi: 10.1016/0020-7101(89)90003-2.
This paper reviews the problems and prospects involved in providing computer-aided decision support in clinical medicine. First, the evaluation of medical innovation is discussed. It is suggested that there are three criteria by which an innovation may be judged, namely (1) a need for the innovation, (2) the ability of the innovation to fulfil that need and (3) the ability to do so without transgressing practical, ethical or legal boundaries. These problems are addressed in turn. The paper suggests, taking one area of clinical medicine as an example (acute abdominal pain) there is a clear need for decision support--since the area is not handled well by doctors in current practice. Evidence is adduced to suggest that the computer can provide decision support and do so without transgressing professional, ethical or legal boundaries. The obstacles to progress, which stand in the way of widespread implementation are briefly discussed. These are lack of medical terminology, poor man-machine interface and above all a lack of co-ordination. Finally, it is suggested that the most valuable facet of current systems is the discipline and precision in data collection they impose upon practicing doctors.
本文回顾了临床医学中提供计算机辅助决策支持所涉及的问题与前景。首先，讨论了医学创新的评估。有人提出，可以依据三个标准来评判一项创新，即：（1）对该创新的需求；（2）该创新满足这种需求的能力；（3）在不违反实际、伦理或法律界限的情况下做到这一点的能力。依次探讨了这些问题。本文以临床医学的一个领域（急性腹痛）为例表明，决策支持存在明确需求——因为目前医生在该领域的处理效果不佳。有证据表明计算机能够提供决策支持，并且在不违反专业、伦理或法律界限的情况下做到这一点。简要讨论了阻碍广泛实施的进展障碍。这些障碍包括医学术语不足、人机界面不佳，尤其是缺乏协调。最后，有人提出当前系统最有价值的方面在于它们要求执业医生在数据收集方面做到的严谨性和精确性。
