Download PDF
Yearb Med Inform 2006; 15(01): 72-80
DOI: 10.1055/s-0038-1638482
Survey
Georg Thieme Verlag KG Stuttgart

Section 5: Decision Support, Knowledge Representation and Management: Decision Support, Knowledge Representation and Management in Medicine

M. Peleg
1   Department of Management Information Systems, University of Haifa, Haifa, Israel
,
S. Tu
2   Stanford Medical Informatics, Stanford University, Stanford, CA, USA
› Author AffiliationsWe would like to thank Dongwen Wang for his very helpful comments and suggestions.
Further Information

Publication History

Publication Date:
07 March 2018 (online)

Also available at
   Permissions and Reprints

Summary

Objectives

Clinical decision-support systems (CDSSs) are being recognized as important tools for improving quality of care. In this paper, we review the literature to find trends in CDSSs that were developed over the last few decades and give some indication of future directions in developing successful, usable clinical decisionsupport systems.

Methods

We searched PubMed for papers that were published during the past five years with the words Decision Support Systems appearing in the title and used our own knowledge of the field for earlier work.

Results

The goals of developers of modern CDSSs are to develop systems that deliver needed information and could be integrated with the healthcare’s organizational dynamics. Such CDSSs form part of knowledge-management activities that healthcare organizations employ in order to excel. During the past few decades, we have witnessed a gradual maturation of knowledge representation formalisms and the needed infrastructure for developing integrated CDSSs, including electronic health record systems (EHR), standard terminologies, and messaging standards for exchange of clinical data. The demand for CDSSs that are effective and that will evolve as circumstances change gave rise to methodologies that guide developers on the construction and evaluation of CDSSs.

Conclusion

Although there exist many approaches for representing, managing and delivering clinical knowledge, the design and implementation of good and useful systems that will last and evolve are still active areas of research. The gradual maturation of EHR and infrastructure standards should make it possible for CDSSs implementers to make major contributions to the delivery of healthcare.

Keywords

Decision Support Systems - Clinical - Knowledge Representation (Computer) - Knowledge Management - Decision Making - Computer-Assisted - Decision Support Techniques
 

  • References

  • 1 Kohn LT, Corrigan JM, Donaldson MS. To Err Is Human: Building a Safer Health System. Washington DC: Committee on Quality of Health Care in America, Institute of Medicine, National Academy Press; 1999
    Google Scholar
  • 2 bInstitute of Medicine. Crossing the Quality Chasm: A New Health System for the 21st Century. National Academy Press; 2001
    Google Scholar
  • 3 Coiera E. Chapter 25 Clinical Decision Support Systems. In: Guide to Health Informatics. (2nd Edition). London: Arnold; 2003
    Google Scholar
  • 4 Hunt DL, Haynes RB, Hanna SE, Smith K. Effects of computer-based clinical decision support systems on physician performance and patient outcomes: a systematic review. JAMA 1998; 280 (15) 1339-46.
    CrossrefPubMedGoogle Scholar
  • 5 Garg AX, Adhikari NKJ, McDonald H, Rosas-Arellano MP, Devereaux PJ, Beyene J. et al. Effects of Computerized Clinical Decision Support Systems on Practitioner Performance and Patient Outcomes: A Systematic Review. JAMA 2005; 293 (10) 1223-38.
    CrossrefPubMedGoogle Scholar
  • 6 Kucher N, Koo S, Quiroz R, Cooper JM, Paterno MD, Soukonnikov B. et al. Electronic Alerts to Prevent Venous Thromboembolism among Hospitalized Patients. N Engl J Med 2005; 352 (10) 969-77.
    CrossrefPubMedGoogle Scholar
  • 7 Musen MA, Shahar Y, Shortliffe EH. Clinical Decision-Support Systems. In: Shortliffe EH, Perreault LE, Wiederhold G, Fagan LM. editors. Medical Informatics: Computer Applications in Health Care and Biomedicine. Second ed.. New York: Springer; 2001: 573-609.
    Google Scholar
  • 8 de-Dombal FT, Leaper DJ, Staniland JR, McCann AP, Horrocks JC. Computer-aided diagnosis of acute abdominal pain. BMJ 1972; (02) 9-13.
    PubMedGoogle Scholar
  • 9 Gorry GA, Kassirer JP, Essig A, Schwartz WB. Decision analysis as the basis for computer-aided management of acute renal failure. American Journal of Medicine 1973; (55) 473-84.
    PubMedGoogle Scholar
  • 10 Shortliffe EH. Computer-based medical consultations: Mycin. New York: Elsevier/North Holland; 1976
    Google Scholar
  • 11 Berg M. Rationalizing Medical Work: Decision-Support Techniques and Medical Practices. Cambridge, MA: The MIT Press; 1997
    Google Scholar
  • 12 Yu VL, Fagan LM, Wraith SM, Clancey WJ, Scott AC, Hannigan J. et al. Antimicrobial selection by a computer. A blinded evaluation by infectious diseases experts. JAMA 1979; 242 (12) 1279-82.
    CrossrefPubMedGoogle Scholar
  • 13 Miller RA, Pople HEJ, Myers JD. Internist-1, an experimental computer-based diagnostic consultant for general internal medicine. N Engl J Med 1982; 307 (08) 468-76.
    CrossrefPubMedGoogle Scholar
  • 14 Wyatt J, Spiegelhalter D. Evaluating medical expert systems: What to test, and how?. In: Knowledgebased systems in medicine: Proceedings of workshop on system enginneering in medicine. Springer: 1991
    Google Scholar
  • 15 Berg M. Patient care information systems and health care work: A sociotechnical approach. Int J Med Inform 1999; 55 (02) 87-101.
    CrossrefPubMedGoogle Scholar
  • 16 Miller RA. Medical diagnostic decision support systems—past, present, and future: a threaded bibliography and brief commentary. J Am Med Inform Assoc 1994; 01 (01) 8-27.
    CrossrefPubMedGoogle Scholar
  • 17 Ruland CM, Bakken S. Developing, implementing, and evaluating decision support systems for shared decision making in patient care: a conceptual model and case illustration. J Biomed Inform 2002; 35 5-6 313-21.
    CrossrefPubMedGoogle Scholar
  • 18 Sim I, Gorman P, Greenes RA, Haynes RB, Kaplan B, Lehmann H. et al. Clinical decision support systems for the practice of evidence-based medicine. J Am Med Inform Assoc 2001; 08 (06) 527-34.
    CrossrefPubMedGoogle Scholar
  • 19 Stefanelli M. Knowledge and Process Management in Health Care Organizations. Methods Inf Med 2004; 43 (05) 525-35.
    Article in Thieme ConnectPubMedGoogle Scholar
  • 20 Schreiber G, Akkermans H, Anjewierden A, de Hoog R, Shadbolt Nigel, Van de Velde W, Wielinga B. Knowledge Engineering and Management: The CommonKADS Methodology. Cambridge, MA: The MIT Press; 2000
    Google Scholar
  • 21 Quaglini S, Stefanelli M, Cavallini A, Micieli G, Fassino C, Mossa C. Guideline-Based Careflow Systems. Artif Intell Med 2000; 05 (22) 5-22.
    PubMedGoogle Scholar
  • 22 Rumbaugh, Jacobson, Booch. The Unif ied Modeling Language Reference Manual. Addison-Wesley: 1999
    Google Scholar
  • 23 Osheroff JA, Pifer EA, Sittig DF, Jenders RA, Teich JM. Clinical Decision Support Implementer’s Workbook. In: HIMSS 2004 www.himss.org/ASP/topics_cds_workbook.asp?faid=108&tid=14
    PubMedGoogle Scholar
  • 24 Berg M, Toussaint P. The mantra of modeling and the forgotten powers of paper: a sociotechnical view on the development of process-oriented ICT in health care. Int J Med Inform 2003; 69 2-3 223-34.
    CrossrefPubMedGoogle Scholar
  • 25 Nonaka I, Takeuchi H. The Knowledge-Creating Company: How Japanese Companies Create the Dynamics of Innovation. Oxford University Press; 1995
    Google Scholar
  • 26 Panzarasa S, Madde S, Quaglini S, Pistarini C, Stefanelli M. Evidence-based careflow management systems: the case of post-stroke rehabilitation. J Biomed Inform 2002; 35 (02) 123-39.
    CrossrefPubMedGoogle Scholar
  • 27 Gaines BR, Shaw MLG. WebGrid: knowledge modeling and inference through the World Wide Web. In: Musen BRGaM. editor. Proceedings of the Tenth Knowledge Acquisition for Knowledge-Based Systems Workshop; 1996; Banff. 1996. 65-1–65-14.
    Google Scholar
  • 28 Eshelman L, Ehret D, McDermott J, Tan M. MOLE: A tenacious knowledge-acquisition tool. Int J of Man-Machine Studies 1987; 26 (01) 41-54.
    PubMedGoogle Scholar
  • 29 Woolery LK, Grzymala-Busse J. Machine learning for an expert system to predict preterm birth risk. J Am Med Inform Assoc 1994; 01 (06) 439-46.
    CrossrefPubMedGoogle Scholar
  • 30 Peleg M, Steele R, Thomson R, Patkar V, Fox J. Open-source Publishing of Medical Knowledge. In: Tenth Conference on Artificial Intelligence in Medicine. 2005. Lecture Notes in Computer Science; Vol 3581.
    Google Scholar
  • 31 Noy NF, Klein M. Ontology Evolution: Not the Same as Schema Evolution. Knowledge and Information Systems 2003; 06 (04) 428-40.
    PubMedGoogle Scholar
  • 32 Cimino JJ. Formal Descriptions and Adaptive Mechanisms for Changes in Controlled Medical Vocabularies. Methods Inf Med 1996; 35: 202-10.
    Article in Thieme ConnectPubMedGoogle Scholar
  • 33 Oliver DE, Shahar Y. Change Management of Shared and Local Versions of Health-Care Terminologies. Methods Inf Med 2000; 39: 278-90.
    Article in Thieme ConnectPubMedGoogle Scholar
  • 34 Peleg M, Kantor R. Approaches for guideline versioning using GLIF. In: Proc AMIA Symp 2003; 509-13.
    PubMedGoogle Scholar
  • 35 Berrios DC, Cucina RJ, Fagan LM. Methods for semi-automated indexing for high precision information retrieval. J Am Med Inform Assoc 2002; 09 (06) 637-52.
    CrossrefPubMedGoogle Scholar
  • 36 Bernstam E. MedlineQBE (Query-by-Example). In: Proc AMIA Symp 2001; 47-51.
    PubMedGoogle Scholar
  • 37 Shortliffe EH, Buchanan BG, Feifenbaum EA. Knowledge engineering for medical decisionmaking: a review of computer-based clinical deicision aids. Proc. IEEE 1997; 67: 1207-24.
    PubMedGoogle Scholar
  • 38 Gruber TR. Toward Principles for the Design of Ontologies Used for Knowledge Sharing. Int Journal of Human-Computer Studies 1995; 43: 907-28.
    PubMedGoogle Scholar
  • 39 Schulze-Kremer S. Ontologies for Molecular Biology. In: Proceedings of the Third Pacific Symposium on Biocomputing 1998; 693-704.
    PubMedGoogle Scholar
  • 40 Field MJ, Lohr KN. Guidelines for Clinical Practice: Directions for a New Program. Washington DC: Institute of Medicine, National Academy Press; 1990
    Google Scholar
  • 41 Peleg M, Tu SW, Bury J, Ciccarese P, Fox J, Greenes RA. et al. Comparing Computer-Interpretable Guideline Models: A Case-Study Approach. J Am Med Inform Assoc 2003; 10 (01) 52-68.
    CrossrefPubMedGoogle Scholar
  • 42 de-Clercq PA, Blom JA, Korsten HHM, Hasman A. Approaches for creating computer-interpretable guidelines that facilitate decision support. Artif Intell Med 2004; 31: 1-27.
    CrossrefPubMedGoogle Scholar
  • 43 Thomson R. Guideline Modelling Methods Summeries. In: Open Clinical Organization 2005 http://www.openclinical.org/gmmsummaries.html.
    PubMedGoogle Scholar
  • 44 Murley D, Rees S, Rasmussen B, Andreassen S. Decision support of inspired oxygen selection based on Bayesian learning of pulmonary gas exchange parameters. Artif Intell Med 2005; 34 (01) 53-63.
    CrossrefPubMedGoogle Scholar
  • 45 Ohlsson M. WeAidU-a decision support system for myocardial perfusion images using artificial neural networks. Artif Intell Med 2004; 30 (01) 49-60.
    CrossrefPubMedGoogle Scholar
  • 46 Ogunyemi O, Clarke JR, Ash N, Webber BL. Combining geometric and probabilistic reasoning for computer-based penetrating-trauma assessment. J Am Med Inform Assoc 2002; 09 (03) 273-82.
    CrossrefPubMedGoogle Scholar
  • 47 Quaglini S, Dazzi L, Gatti L, Stefanelli M, Fassino C, Tondini C. Supporting tools for guideline development and dissemination. Artif Intell Med 1998; 14 1-2 119-37.
    CrossrefPubMedGoogle Scholar
  • 48 Jerez-Aragones JM, Gomez-Ruiz JA, Ramos-Jimenez G, Munoz-Perez J, Alba-Conejo E. A combined neural network and decision trees model for prognosis of breast cancer relapse. Artif Intell Med 2003; 27 (01) 45-63.
    CrossrefPubMedGoogle Scholar
  • 49 Horvitz EJ, Breese JS, Henrion M. Decision Theory in Expert Systems and AI. Intl J Approximate Reasoning 1988; 02 (03) 247-302.
    PubMedGoogle Scholar
  • 50 Peleg M, Boxwala AA, Bernstam E, Tu S, Greenes RA, Shortliffe EH. Sharable Representation of Clinical Guidelines in GLIF: Relationship to the Arden Syntax. J Biomed Inform 2000; 34 (03) 170-81.
    PubMedGoogle Scholar
  • 51 Beliakov G, Warren J. Fuzzy logic for decision support in chronic care. Artif Intell Med 2001; 21 1-3 209-13.
    CrossrefPubMedGoogle Scholar
  • 52 Bates DW, Kuperman GJ, Wang S, Gandhi T, Kittler A, Volk L. et al. Ten Commandments for Effective Clinical Decision Support: Making the Practice of Evidence-based Medicine a Reality. J Am Med Inform Assoc 2003; 10 (06) 523-30.
    CrossrefPubMedGoogle Scholar
  • 53 Wetter T. Lessons learnt from bringing knowledgebased decision support into routine use. Artif Intell Med 2002; 24 (03) 195-203.
    CrossrefPubMedGoogle Scholar
  • 54 Kawamoto K, Houlihan CA, Balas EA, Lobach DF. Improving clinical practice using clinical decision support systems: a systematic review of trials to identify features critical to success. BMJ 2005; 330 (7494): 765.
    CrossrefPubMedGoogle Scholar
  • 55 Electronic Decision Support Subgroup. Electronic Decision Support Evaluation Methodology. In: Australian Health Information Council 2005 http://www.ahic.org.au/subgroups/EDSevaluation.html.
    PubMedGoogle Scholar
  • 56 Cimino JJ, Li J, Bakken S, Patel VL. Theoretical, empirical and practical approaches to resolving the unmet information needs of clinical information system users. In: Proc AMIA Symp 2002; 170-4.
    PubMedGoogle Scholar
  • 57 Wyatt J. Evaluation of Clinical Information Systems. In: van Bemmel JH, Musen MA. editors. Handbook of Medical Informatics. Springer: 1997
    Google Scholar
  • 58 Friedman CP, Wyatt JC. Evaluation Methods in Medical Informatics. 1st ed.. New York: Springer; 1997
    Google Scholar
  • 59 Smith AE, Nugent CD, McClean SI. Evaluation of inherent performance of intelligent medical decision support systems: utilising neural networks as an example. Artif Intell Med 2003; 27 (01) 1-27.
    CrossrefPubMedGoogle Scholar
  • 60 Wears RL, Berg M. Computer Technology and Clinical Work: Still Waiting for Godot. JAMA 2005; 293 (10) 1261-3.
    CrossrefPubMedGoogle Scholar
  • 61 Cheng C, Goldstein M, Geller E, Levitt R. The Effects of CPOE on ICU workflow: an observational study. In: AMIA Annu Symp Proc 2003; 150-4.
    PubMedGoogle Scholar
  • 62 Heathfield H, Pitty D, Hanka R. Evaluating information technology in health care: barriers and challenges. BMJ 1998; 316 7149 1959-61.
    CrossrefPubMedGoogle Scholar
  • 63 National Electronic Decision Support Task Force. Electronic Decision Support for Australia’s Health Sector. 2003 http://www.ahic.org.au/downloads/nedsrept.pdf.
    PubMedGoogle Scholar