Zielstorff R D, Barnett G O, Fitzmaurice J B, Estey G, Hamilton G, Vickery A, Welebob E, Shahzad C
Laboratory of Computer Science, Massachusetts General Hospital, Boston, USA.
Proc AMIA Annu Fall Symp. 1996:562-6.
We have developed a Pressure Ulcer Prevention and Management System to assist clinicians with patient-specific decision making. The system captures coded data about assessment, diagnosis and interventions using a point-and-click interface. Guideline-based knowledge is imbedded into the system, and is accessible in several ways: 1) via hypertext links from the data entry screens; 2) via explicit entry into an indexed version of the guideline; 3) via imbedded knowledge-based rules that critique the diagnosis and offer guidance for treatment; and 4) via explicit entry into interactive algorithms. The system has been implemented experimentally on one care unit at our hospital, where its impact will be assessed in comparison with a control unit. Preliminary usage data are provided. Issues with rendering guideline material useful for patient-specific decision support are discussed. In our setting, these issues had to do with a) incongruity with local standards; b) insufficient specificity; and 3) insufficient comprehensiveness. Issues of use and dissemination in the context of today's health care environment are also addressed.
我们开发了一种压疮预防与管理系统，以协助临床医生进行针对患者的决策。该系统使用点击界面来获取有关评估、诊断和干预措施的编码数据。基于指南的知识嵌入到系统中，并可以通过多种方式访问：1）通过数据输入屏幕的超文本链接；2）通过明确输入指南的索引版本；3）通过嵌入的基于知识的规则，对诊断进行评判并提供治疗指导；4）通过明确输入交互式算法。该系统已在我院的一个护理单元进行了实验性实施，在那里将与一个对照单元进行比较，以评估其影响。提供了初步使用数据。讨论了使指南材料对针对患者的决策支持有用所存在的问题。在我们的环境中，这些问题与以下方面有关：a）与当地标准不一致；b）特异性不足；以及c）全面性不足。还探讨了在当今医疗保健环境背景下的使用和传播问题。
