Middleton B, Sittig D F, Wright A
Blackford Middleton, Cell: +1 617 335 7098, E-Mail:
Yearb Med Inform. 2016 Aug 2;Suppl 1(Suppl 1):S103-16. doi: 10.15265/IYS-2016-s034.
The objective of this review is to summarize the state of the art of clinical decision support (CDS) circa 1990, review progress in the 25 year interval from that time, and provide a vision of what CDS might look like 25 years hence, or circa 2040.
Informal review of the medical literature with iterative review and discussion among the authors to arrive at six axes (data, knowledge, inference, architecture and technology, implementation and integration, and users) to frame the review and discussion of selected barriers and facilitators to the effective use of CDS.
In each of the six axes, significant progress has been made. Key advances in structuring and encoding standardized data with an increased availability of data, development of knowledge bases for CDS, and improvement of capabilities to share knowledge artifacts, explosion of methods analyzing and inferring from clinical data, evolution of information technologies and architectures to facilitate the broad application of CDS, improvement of methods to implement CDS and integrate CDS into the clinical workflow, and increasing sophistication of the end-user, all have played a role in improving the effective use of CDS in healthcare delivery.
CDS has evolved dramatically over the past 25 years and will likely evolve just as dramatically or more so over the next 25 years. Increasingly, the clinical encounter between a clinician and a patient will be supported by a wide variety of cognitive aides to support diagnosis, treatment, care-coordination, surveillance and prevention, and health maintenance or wellness.
本综述的目的是总结1990年左右临床决策支持（CDS）的发展现状，回顾自那时起25年间的进展，并展望25年后（即2040年左右）CDS可能的面貌。
对医学文献进行非正式综述，并在作者之间进行反复审查和讨论，得出六个轴（数据、知识、推理、架构与技术、实施与整合以及用户），以构建对CDS有效应用的选定障碍和促进因素的综述与讨论。
在这六个轴的每一个方面都取得了显著进展。在构建和编码标准化数据方面取得关键进展，数据可用性增加；为CDS开发知识库；提高共享知识工件的能力；分析和从临床数据进行推理的方法激增；信息技术和架构不断演进以促进CDS的广泛应用；改进实施CDS并将其整合到临床工作流程中的方法；以及终端用户日益成熟，所有这些都在改善CDS在医疗服务中的有效应用方面发挥了作用。
CDS在过去25年中发生了巨大演变，未来25年可能也会同样剧烈甚至更大程度地演变。临床医生与患者之间的临床接触将越来越多地得到各种认知辅助工具的支持，以辅助诊断、治疗、护理协调、监测与预防以及健康维护或促进。
