Difference between revisions of "Interaction model"

Revision as of 17:53, 17 November 2011

Clinical decision support (CDS) are rules in user interaction model for making clinical decisions. The rules are based on a large collection of medical knowledge and an accurate computer representation scheme.

Introduction

Informaticians have been developing knowledge-based clinical decision support systems for over 30 years with many notable successes [1]

Nature of the medical decision

The key item that must be considered is the nature of the medical decision being made. Many medical decisions are based on numerous simple and widely agreed upon, rules that all clinicians know but have difficulty bringing to bear with 100% accuracy.

Examples of such decisions might include

• Does this infant need an MMR vaccination today?
• Do these particular arterial blood gas values represent a metabolic or respiratory acidosis?
• Has the patient's sodium value fallen more than 25% over the last 12 hours?

These determinations are best implemented as interpretation or monitoring systems.

no clear cut solutions

Other decisions are fraught with complicated risk assessments and competing alternatives; they have no clear-cut "best" solutions. Such decisions are best implemented as critiquing systems. The consultation mode, on the other hand, has not met with much success in the clinical realm for the simple reason that clinicians are reluctant to spend extended periods of time entering data into a computer in order to receive advice. Finding the appropriate user interaction model is one of the most important, but often overlooked, tasks.

Any of the above mentioned interaction models can be enhanced by offering a "teaching mode" to the user. Such a mode would allow the system to "explain" its reasoning to the clinician. In a landmark article, Teach and Shortliffe stated that the ability of a system to "explain" its reasoning was one of the key factors in clinician acceptance of decision support systems [Teach, 1981]. Since that time many systems have been successfully deployed without this capability, although system developers are still encouraged to provide it when possible. Many developers skirt this issue by citing a scientific journal article or displaying the actual rules (along with the patient's data values) the system used to reach the conclusion.

1. Teach RL, Shortliffe EH. An analysis of physician attitudes regarding computer-based clinical consultation systems. Comput Biomed Res 1981 Dec;14(6):542-58

References

1. Reisman Y. [2] Computer-based clinical decision aids]. A review of methods and assessment of systems. Med Inf (Lond) 1996 Jul-Sep;21(3):179-97