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医生医嘱录入的临床决策支持：设计挑战

Clinical decision support for physician order-entry: design challenges.

作者信息

Broverman C A, Clyman J I, Schlesinger J M, Want E

机构信息

ALLTEL Information Services, Health Care Division San Jose, California, USA.

出版信息

Proc AMIA Annu Fall Symp. 1996:572-6.

PMID:8947731
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC2233004/
Abstract

We report on a joint development effort between ALLTEL Information Services Health Care Division and IBM Worldwide Healthcare Industry to demonstrate concurrent clinical decision support using Arden Syntax at order-entry time. The goal of the partnership is to build a high performance CDS toolkit that may be easily customized for multiple health care enterprises. Our work uses and promotes open technologies and health care standards while building a generalizable interface to a legacy patient-care system and clinical database. This paper identifies four areas of design challenges and solutions unique to a concurrent order-entry environment: the clinical information model, the currency of the patient virtual chart, the granularity of event triggers and rule evaluation context, and performance.

摘要

我们报告了ALLTEL信息服务医疗保健部门与IBM全球医疗保健行业之间的一项联合开发工作，旨在展示在医嘱录入时使用Arden语法进行并发临床决策支持。该合作关系的目标是构建一个高性能的临床决策支持工具包，该工具包可以轻松地为多个医疗保健企业进行定制。我们的工作在构建与遗留患者护理系统和临床数据库的通用接口时，采用并推广开放技术和医疗保健标准。本文确定了并发医嘱录入环境特有的四个设计挑战领域及解决方案：临床信息模型、患者虚拟图表的时效性、事件触发和规则评估上下文的粒度以及性能。

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引用本文的文献

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Embedding guidelines into direct physician order entry: simple methods, powerful results.将指南嵌入医生直接医嘱录入系统：方法简单，效果显著。
Proc AMIA Symp. 1999:221-5.
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An industrial process view of information delivery to support clinical decision making: implications for systems design and process measures.一种支持临床决策的信息传递的工业流程视角：对系统设计和流程措施的启示
J Am Med Inform Assoc. 1997 Jul-Aug;4(4):266-78. doi: 10.1136/jamia.1997.0040266.

本文引用的文献

1
Physician inpatient order writing on microcomputer workstations. Effects on resource utilization.医生在微型计算机工作站上书写住院医嘱。对资源利用的影响。
JAMA. 1993 Jan 20;269(3):379-83.
2
Using a hospital information system to assess the effects of adverse drug events.利用医院信息系统评估药物不良事件的影响。
Proc Annu Symp Comput Appl Med Care. 1993:161-5.
3
Rationale for the Arden Syntax.Arden语法的基本原理。
Comput Biomed Res. 1994 Aug;27(4):291-324. doi: 10.1006/cbmr.1994.1023.

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