Clinical Decision Support SystemsOverviewScope of Clinical Decision Support SystemsDefinitionCategoriesSlide 6Tools for Information ManagementTools for Focusing AttentionTools for Patient-Specific ConsultationAlternative (more specific) DefinitionCharacterizing Decision-Support SystemsPassive SystemsPassive Systems (cont.)Active SystemsActive Systems (cont.)Need for CDSSApplication AreasPossible Disadvantages of CDSSIssues for success or failureEvaluation of Clinical Decision Support SystemsCriteria for a clinically useful DSSCriteria for a clinically useful DSS (cont.)Aspects for Evaluation of a CDSSComputing techniques used to create DSSDesign Cycle for the development of a CDSSEarly AI/Decision Support Systems.Slide 27Example: Decision Tree 1Example: Decision Tree 2Slide 30Example: Decision Rule 1System MYCIN – a Decision RuleSystem MYCIN – Explanation ExampleSystem HELP – MLM ExampleSystem ONCOCIN – Cancer-Treatment Protocol ExampleSuccessful CDS SystemsSuccessful CDS Systems (cont.)Slide 38Open Source Medical Decision Support SystemSlide 40Existing Medical DSS SystemsProposed SolutionSlide 43Features of DSSSlide 45Slide 46IssuesIssues (cont.)Existing Open Source ExampleWhere do we go from here?SourcesCDSS-1CSE 300 Clinical Decision Support Systems Clinical Decision Support Systems Mohammed Saleem Mohammed SaleemCDSS-2CSE 300 OverviewOverviewScope of Clinical Decision Support SystemsScope of Clinical Decision Support SystemsIssues for success or failureIssues for success or failureEvaluation of Clinical Decision Support Evaluation of Clinical Decision Support SystemsSystemsComputing techniques used to create DSSComputing techniques used to create DSSDesign Cycle for the development of DSSDesign Cycle for the development of DSSEarly AI/Decision Support Systems. Early AI/Decision Support Systems. Open source Example Open source ExampleCDSS-3CSE 300 Scope of Clinical Decision Support SystemsScope of Clinical Decision Support SystemsDefinitionDefinitionCategories of CDSSCategories of CDSSSystem Architecture System Architecture Advantages / Need for CDSSAdvantages / Need for CDSSApplications AreasApplications AreasDisadvantagesDisadvantagesCDSS-4CSE 300 DefinitionDefinitionA A clinical decision-support systemclinical decision-support system is any is any computer program designed to help health computer program designed to help health professionals make clinical decisions.professionals make clinical decisions.In a sense, In a sense, anyany computer system that deals computer system that deals with clinical data or medical knowledge is with clinical data or medical knowledge is intended to provide decision support.intended to provide decision support.Three types of decision-support function, Three types of decision-support function, ranging from generalized to patient specific.ranging from generalized to patient specific.CDSS-5CSE 300 CategoriesCategoriesGenerating alerts and remindersGenerating alerts and remindersDiagnostic assistanceDiagnostic assistanceTherapy critiquing and planningTherapy critiquing and planningImage recognition and interpretationImage recognition and interpretationCDSS-6CSE 300 Inference EngineClinicalDataRepository(CDR)UserKnowledge BaseEvent MonitorNotifierRecipient(s)CDSS-7CSE 300 Tools for Information ManagementTools for Information ManagementExamples:Examples:Hospital information systemsBibliographic retrieval systems (PubMed)Specialized knowledge-management workstations (e.g. electronic textbooks, …)These tools provide the data and knowledge These tools provide the data and knowledge needed, but they do not help to needed, but they do not help to applyapply that that information to a particular decision task information to a particular decision task (particular patient)(particular patient)CDSS-8CSE 300 Tools for Focusing AttentionTools for Focusing AttentionExamples:Examples:Clinical laboratory systems that flag abnormal values or that provide lists of possible explanations for those abnormalities.Pharmacy systems that alert providers to possible drug interactions or incorrect drug dosagesAre designed to remind the physician of Are designed to remind the physician of diagnoses or problems that might be diagnoses or problems that might be overlooked.overlooked.CDSS-9CSE 300 Tools for Patient-Specific ConsultationTools for Patient-Specific ConsultationProvide customized assessments or advice Provide customized assessments or advice based on sets of patient-specific data:based on sets of patient-specific data:Suggest differential diagnosesAdvice about additional tests and examinations Treatment advice (therapy, surgery, …)CDSS-10CSE 300 Alternative (more specific) DefinitionAlternative (more specific) DefinitionClinical decision support systems are Clinical decision support systems are active active knowledge systems knowledge systems which use two or more which use two or more items of patient data to generate case-specific items of patient data to generate case-specific advice.advice.Main components:Main components:Medical knowledgePatient dataCase-specific adviceCDSS-11CSE 300 Characterizing Decision-Support SystemsCharacterizing Decision-Support SystemsSystemSystem functionfunctionDetermining what is true about a patient (e.g. correct diagnosis)Determining what to do (what test to order, to treat or not, what therapy plan …)The mode for giving adviceThe mode for giving advicePassive role (physician uses the system when advice needed)Active role (the system gives advice automatically under certain conditions)CDSS-12CSE 300 Passive SystemsPassive SystemsThe user has total control:The user has total control:Requires adviceAnalyses the adviceAccepts/Rejects the adviceDomain of use:Domain of use:Wide domain like internal medicineExamples: QMR, DXPLAINNarrow domainAcute abdominal painAnalysis of ECGCDSS-13CSE 300 Passive Systems (cont.)Passive Systems (cont.)Characteristics:Characteristics:Stand-aloneData entry:System initiativeUser initiativeConsultation styleConsulting modelCritiquing modelCDSS-14CSE 300 Active SystemsActive SystemsThe user has partial controlThe user has partial controlSystem gives adviceUser evaluates the adviceThe user accepts/rejects the adviceDomain of useDomain of useLimited domainDrug