Medlock Stephanie, Wyatt Jeremy C, Patel Vimla L, Shortliffe Edward H, Abu-Hanna Ameen
Department of Medical Informatics, University of Amsterdam, Amsterdam, The Netherlands
Yorkshire Centre for Health Informatics, University of Leeds, Leeds, UK Wessex Institute of Health, University of Southampton, Southampton, UK
J Am Med Inform Assoc. 2016 Sep;23(5):1001-6. doi: 10.1093/jamia/ocv177. Epub 2016 Feb 5.
A fundamental challenge in the field of clinical decision support is to determine what characteristics of systems make them effective in supporting particular types of clinical decisions. However, we lack such a theory of decision support itself and a model to describe clinical decisions and the systems to support them. This article outlines such a framework. We present a two-stream model of information flow within clinical decision-support systems (CDSSs): reasoning about the patient (the clinical stream), and reasoning about the user (the cognitive-behavioral stream). We propose that CDSS "effectiveness" be measured not only in terms of a system's impact on clinical care, but also in terms of how (and by whom) the system is used, its effect on work processes, and whether it facilitates appropriate decisions by clinicians and patients. Future research into which factors improve the effectiveness of decision support should not regard CDSSs as a single entity, but should instead differentiate systems based on their attributes, users, and the decision being supported.
临床决策支持领域的一个基本挑战是确定系统的哪些特征使其在支持特定类型的临床决策方面有效。然而，我们缺乏这样一种决策支持理论本身以及一个描述临床决策和支持这些决策的系统的模型。本文概述了这样一个框架。我们提出了临床决策支持系统（CDSS）内信息流的双流模型：关于患者的推理（临床流）和关于用户的推理（认知行为流）。我们建议，衡量CDSS的“有效性”不仅要依据系统对临床护理的影响，还要依据系统的使用方式（以及由谁使用）、其对工作流程的影响，以及它是否促进临床医生和患者做出恰当的决策。未来关于哪些因素能提高决策支持有效性的研究不应将CDSS视为一个单一实体，而应根据其属性、用户以及所支持的决策来区分不同的系统。
