Philips Research India, Bangalore, 560045, India.
Department of Radiation Oncology (MAASTRO), GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, 6229 ET, Netherlands.
Med Phys. 2020 Jun;47(5):e228-e235. doi: 10.1002/mp.13562.
Recent advances in machine and deep learning based on an increased availability of clinical data have fueled renewed interest in computerized clinical decision support systems (CDSSs). CDSSs have shown great potential to improve healthcare, increase patient safety and reduce costs. However, the use of CDSSs is not without pitfalls, as an inadequate or faulty CDSS can potentially deteriorate the quality of healthcare and put patients at risk. In addition, the adoption of a CDSS might fail because its intended users ignore the output of the CDSS due to lack of trust, relevancy or actionability.
In this article, we provide guidance based on literature for the different aspects involved in the adoption of a CDSS with a special focus on machine and deep learning based systems: selection, acceptance testing, commissioning, implementation and quality assurance.
A rigorous selection process will help identify the CDSS that best fits the preferences and requirements of the local site. Acceptance testing will make sure that the selected CDSS fulfills the defined specifications and satisfies the safety requirements. The commissioning process will prepare the CDSS for safe clinical use at the local site. An effective implementation phase should result in an orderly roll out of the CDSS to the well-trained end-users whose expectations have been managed. And finally, quality assurance will make sure that the performance of the CDSS is maintained and that any issues are promptly identified and solved.
We conclude that a systematic approach to the adoption of a CDSS will help avoid pitfalls, improve patient safety and increase the chances of success.
基于临床数据可用性的提高,机器和深度学习方面的最新进展重新激发了人们对计算机临床决策支持系统(CDSS)的兴趣。CDSS 具有改善医疗保健、提高患者安全性和降低成本的巨大潜力。然而,CDSS 的使用并非没有陷阱,因为不充分或有缺陷的 CDSS 可能会降低医疗保健质量,并使患者面临风险。此外,由于缺乏信任、相关性或可操作性,CDSS 的采用可能会失败,因为其预期用户会忽略 CDSS 的输出。
本文基于文献为采用 CDSS 的各个方面提供指导,特别关注基于机器和深度学习的系统:选择、接受测试、委托、实施和质量保证。
严格的选择过程将有助于确定最符合当地站点偏好和要求的 CDSS。接受测试将确保所选的 CDSS 满足定义的规范并满足安全要求。调试过程将为 CDSS 在当地站点的安全临床使用做好准备。有效的实施阶段应导致 CDSS 有条不紊地推广给经过良好培训的最终用户,同时管理好他们的期望。最后,质量保证将确保 CDSS 的性能得到维持,并且及时发现和解决任何问题。
我们的结论是,采用 CDSS 的系统方法将有助于避免陷阱,提高患者安全性并增加成功的机会。