Clinical Decision Support Systems: Theory and Practice PDF
Preview Clinical Decision Support Systems: Theory and Practice
Health Informatics (formerlyComputers inHealth Care) Kathryn J. Hannah Marion J. Ball SeriesEditors SpringerScience+Business Media, LLC Health Informatics (formerly Computers in Health Care) SeriesEditors: Kathryn J. Hannah Marion J. Ball DentalInformatics Integrating Technology into the Dental Environment L.M. Abbey andJ.Zimmerman Aspectsof theComputer-based Patient Record MJ. BallandM.F. Collen NursingInformatics Where Caringand Technology Meet,Second Edition MJ. Ball, KJ. Hannah, S.K. Newbold, andlV. Douglas HealthcareInformation Management Systems APractical Guide, Second Edition MJ.Ball, D.W. Simborg, lW. Albright, andlV. Douglas Clinical DecisionSupport Systems Theory and Practice E.S. Berner Strategyand Architecture of HealthCare Information Systems M.K. Bourke Information Networks forCommunity Health P.F.Brennan, S.J.Schneider, andE.Tornquist Introduction to Medical Informatics P. Degouletand M.Fieschi PatientCare Information Systems Successful Design and Implementation E.L.Drazen,1.8. Metzger, J.L.Ritter, and M.K. Schneider Introduction toNursing Informatics KJ. Hannah,MJ.Ball, and MJ.A. Edwards Computerizing Large Integrated Health Networks The VASuccess R.M. Kolodner Organizational Aspectsof Health Informatics Managing Technological Change N.M.Lorenzi and R.T. Riley Transforming HealthCareThrough Information CaseStudies N.M.Lorenzi,R.T.Riley, MJ.Ball,and J.V. Douglas (continued after Index, Eta S.Berner Editor Clinical Decision Support Systems Theory and Practice With aForeword byMarion J. Ball With 11Illustrations ~, T Springer EtaS.Berner,EdD Section ofMedical Informatics Professor,Masters ofScienceinHealth Division ofGeneralMedicine InformaticsProgram DepartmentofMedicine DepartmentofHealthServices School ofMedicine Administration University ofAlabama School ofHealthRelatedProfessions 1675UniversityBoulevard,Room 544 and Birmingham,AL35294-8219,USA SeriesEditors: KathrynJ.Hannah,PhD,RN MarionJ.Ball,EdD Leader,HealthInformaticsGroup Professor,Departmentof SierraSystemsConsultants,Inc. Epidemiology and UniversityofMarylandSchoolof Professor,DepartmentofCommunity Medicine HealthScience and FacultyofMedicine VicePresident TheUniversityofCalgary FirstConsultingGroup Calgary,Alberta,Canada Baltimore,MD,USA LibraryofCongressCataloging-in-PublicationData Clinicaldecisionsupportsystemsintheoryandpractice/[editedby) EtaS.Berner. p. cm.-(Healthinformatics) Includesbibliographicalreferencesand index. I.Diagnosis-Decisionmaking-Dataprocessing. 2.Clinical medicine-Decisionmaking-Dataprocessing. 3.Expertsystems (Computerscience) I.Berner,EtaS.,1946-. II.Series. [DNLM:I.DecisionSupportSystems,Clinical. 2.Diagnosis, Computer-Assisted. 3.ExpertSystems. WB141C63711998) RC78.7.D35C55 1998 616.07'5'0285-<1c21 DNLM/DLC 98-21883 Printedonacid-free paper. e 1999SpringerScience+BusinessMediaNewYork OriginallypublishedbySpringer-VerlagNewYork,Incin1999. Softcoverreprintofthehardcover Istedition1999 Allrightsreserved.Thisworkmaynotbetranslatedorcopiedinwholeorpartwithoutthewritten permissionofthepublisher(Springer-VerlagNewYork,lnc.,175FifthAvenue,NewYork,NY10010, USA),exceptforbriefexcerptsinconnectionwithreviewsorscholarlyanalysis.Useinconnection withanyformofinformationstorageandretrieval,electronicadaptation,computersoftware,orby similarordissimilarmethodologynowknownorhereafterdevelopedisforbidden. The useofgeneraldescriptivenames, tradenames, trademarks,etc.,in thispublication,evenif theformer arenotespeciallyidentified,isnottobetakenasasignthatsuchnames,asunderstood bytheTradeMarksand MerchandiseMarksAct,mayaccordinglybeusedfreelybyanyone. Whiletheadviceand informationinthisbookarebelievedtobetrueandaccurateatthedateof goingtopress,neithertheauthorsnortheeditorsnorthepublishercanacceptanylegalrespon sibilityforanyerrorsoromissionsthatmaybemade.Thepublishermakesnowarranty,express orimplied,withrespect tothematerialcontained herein. ProductioncoordinatedbyA.Orrantia;manufacturingsupervisedbyJoeQuatela, PhotocomposedbyMichelleM.Stroveglia,Massapequa,NY. 9 8 765 4 3 2 1 SPIN 10682325 ISBN978-1-4757-3905-3 ISBN978-1-4757-3903-9(eBook) DOl 10.1007/978-1-4757-3903-9 To David, Daniel, andJacob =====FOREWORD============= Thisexciting volume willilluminateourpathasweentertheknowl edgeeraofthe2151century.Wefindhererealcasestudiesthatchronicle the successfuluseofdecision supportandexpertsystemsinhealthcare. In demonstratingthe knowledge transferprocess,these casestakewhat has been theory into the actual practice of medicine and health care delivery.Thesearechangesofthe highestorder, andthe transformation they promiseisdependent upon ouraddressingtwo vitalandvery dif ferent components. • One involves "peopleware" and requires that we bring cognitive scientists,behaviorists,andsocialscientistsinto health informatics. • The otherishighlytechnicaland involvesthe "engine"thatdrives systems,creatingknowledge andshapinghealthcaredelivery. Bothareessentialcomponentsasweworktobringknowledgetowhere it isneeded,be it the bedside,the home, the classroom,the office,or the researchbench.Thoseofuswhohavelaboredtomakehealthinformaticsa recognized discipline know the difficulties involved in taking new ap proaches togatheringdata,seekinginformation,andcreatingknowledge. Weneed newtoolsetsand newmindsetsasweenterthe 2151century.This isatallorder,but itcanbemet,asthisvolume sorichlydemonstrates. For added insights, welook to the workon organizational devel opmentreportedbyNancyLorenziandRobertRileyearlierinthe Com- .puters in Health Care series.They address the "soft issues" that have proved to be hard realitiesin far too many information system imple mentations. Welook to cognitive scientists. likeVimla Patel, who are showingus howwecan make tools thatare intuitive,responsive to and reflectiveofdifferentlearningandinformation-seekingstyles. The premise of this Springerseries-and the conviction that has governedourprofessionallives-isthathealthinformaticscan improve care.Today the engine that drives health care information systems is more powerful thaneverbefore.Weare already realizing the benefitof new communication capabilities. And these promise to increase expo nentially once advances like Sequoia's extended mark-up language (XML) solve the problems of data entry and fileconversion, making healthrecordsshareableacrossthe Internet,abletopopulatedata ware housesandknowledge repositories. Asevidence-based medicine becomes a reality,we will be in for exciting times.Managingthis knowledge-drivenenterprisewillrequire newskills,processes,and policies.Butwith theseriskscomenewoppor tunities, for health care organizations and for individuals givingor re ceivinghealthcare. vii viii Foreword Preparingto enterthisboldnewworld,weoweatremendousdebt ofgratitudeto EtaBernerandto the informaticianswho contributedto thisvolume.Togethertheyhavegivenusthecompassthatwillhelpguide uson ourway. Mariont. Ball ===========SERIES PREFACE========= This series is directed to healthcare professionals who are leading the transformationofhealthcare byusing informationand knowl edge.Launchedin 1988asComputersin HealthCare,theseriesoffersa broad range oftitles: someaddressed to specific professions like nurs ing, medicine, or health administration; otherto special areas ofprac ticesuch astraumaor radiology.Stillotherbooks in the seriesfocuson interdisciplinaryissueslikethecomputer-basedpatientrecord,electronic health records ornetworkedhealthcaresystems. RenamedHealthInformaticsin 1998,to reflectthe rapid evolution in the discipline now known as health informatics, the serieswillcon tinuetoadd titlesthatcontributetothecontinuingevolutionofthe field. In the serieseminentexperts, aseditorsor authors,offertheiraccounts ofinnovationsin healthinformatics.Increasingly,theseaccountsgobe yond hardwareandsoftwaretoaddress the roleofinformationin influ encing the transformation ofhealth care delivery systems around the world. The series also will increasingly focus on "peopleware" and the organizational,behavioraland societalchanges thataccompanythe dif fusion ofinformationtechnologyin healthservicesenvironments. These changes willshape health services in the next millennium. Bymaking full and creative use ofthe technology to tame data and to transform information, health informatics will foster the development ofthe knowledge ageinhealthcare.Asco-editors,wepledgeto support ourprofessionalcolleaguesand theseriesreaders astheyshare advances in the emergingandexcitingfieldofHealthInformatics. Kathryn ]. Hannah Marion t.Ball ix ========PREFACE======= Weareat the beginningofa newera in the applicationofcomputer based decision support for clinical medicine. The purpose ofthis bookis to provide an overview ofthe state-of-the-art diagnostic com puterapplications,toidentifytheissuesthatwillneedtobeaddressed as these systems continue to evolve,and to serveas a comprehensive re sourceforphysiciansand otherhealthprofessionals,medicalandhealth informaticsstudents,and researchersinterestedinthedevelopmentand applicationofcomputer-baseddiagnostictools. This book is designed to be (1) a resource book on diagnostic systems for informatics specialists; (2) a textbook for teachers orstu dents in health or medical informatics training programs; and (3) a comprehensive introduction for clinicians, with or without expertise in the applications ofcomputers in medicine, who are interested in learning about current developments in computer-based diagnostic systems.In recentyears,it has becomeobviousthatotherhealth pro fessionals, in addition to physicians, have needs for decision support and that the issues raised in this book apply to this broad range of clinicians. The bookincludes chapters by nationally and internation ally recognized experts on the design, evaluation and application of these systemswho examinethe impactofpractitionerand patientuse ofcomputer-baseddiagnostic tools. The fieldofhealth informatics,in itsbroadestdefinition,involves thedevelopmentand useofsystemsforthemanagementofhealthinfor mation.Thecomputer-basedsystemsthataredescribed inthisbookfo cus on the management ofinformation needed for patient diagnosis. The term "expert system" is often applied to computer-based systems thatareexpectedto provideadvicetoclinicians.Althoughthe label"ex pert system"hasoften been usedloosely,virtuallynoneofthesystemsin operationtodayfunctionwiththeprecisionanddegreeofindependence that would enable them to operate in isolation from the clinician-user, norisitthe intentionofthe developersofthesesystemsthattheydoso. For one thing, these computer systemsusuallygenerate multiple diag nosticsuggestions,ratherthanasingledefinitivediagnosis.Consequently, thosewho usethe systemsmustarriveatadiagnosisbyusingtheirown knowledgeand experience to review,processand adapttheinformation providedbythecomputer.G.Octo Barnett,M.D.,one ofthepioneersin the development ofcomputer-based medical systems,has emphasized thatthecomputerdoesnotdevelopadifferentialdiagnosis,theclinician does. Having appropriate expectations for the manner in which these systemsfunction isessentialtounderstandingtheinformationcontained inthisbook.Forthis reason weusethe term"clinicaldiagnosticdecision xi
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