Clinical Decision Support: a 25 Year Retrospective and a 25 Year Vision

B. Middleton; D. F. Sittig; A. Wright

doi:10.15265/IYS-2016-s034

Yearbook of Medical Informatics, Inhaltsverzeichnis

Yearb Med Inform 2016; 25(S 01): S103-S116
DOI: 10.15265/IYS-2016-s034

Original Article

Georg Thieme Verlag KG Stuttgart

Clinical Decision Support: a 25 Year Retrospective and a 25 Year Vision

Autoren

B. Middleton

¹Apervita, Inc., Chicago, IL, USA

²Harvard T.H. Chan School of Public Health , Boston, MA, USA
D. F. Sittig

³University of Texas Health Science Center at Houston, TX, USA
A. Wright

⁴Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA

Abstract

Summary

Objective: The objective of this review is to summarize the state of the art of clinical decision support (CDS) circa 1990, review progress in the 25 year interval from that time, and provide a vision of what CDS might look like 25 years hence, or circa 2040. Method: Informal review of the medical literature with iterative review and discussion among the authors to arrive at six axes (data, knowledge, inference, architecture and technology, implementation and integration, and users) to frame the review and discussion of selected barriers and facilitators to the effective use of CDS.

Result: In each of the six axes, significant progress has been made. Key advances in structuring and encoding standardized data with an increased availability of data, development of knowledge bases for CDS, and improvement of capabilities to share knowledge artifacts, explosion of methods analyzing and inferring from clinical data, evolution of information technologies and architectures to facilitate the broad application of CDS, improvement of methods to implement CDS and integrate CDS into the clinical workflow, and increasing sophistication of the end-user, all have played a role in improving the effective use of CDS in healthcare delivery.

Conclusion: CDS has evolved dramatically over the past 25 years and will likely evolve just as dramatically or more so over the next 25 years. Increasingly, the clinical encounter between a clinician and a patient will be supported by a wide variety of cognitive aides to support diagnosis, treatment, care-coordination, surveillance and prevention, and health maintenance or wellness.

Keywords

Clinical decision support - electronic health record - health information technology - expert systems - artificial intelligence

Volltext

Referenzen

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