CDSS-1 CSE 300 Clinical Decision Support Systems Clinical Decision Support Systems Mohammed Saleem Mohammed Saleem CDSS-2 CSE 300 Overview Overview  Scope of Clinical Decision Support Systems Scope of Clinical Decision Support Systems  Issues for success or failure Issues for success or failure  Evaluation of Clinical Decision Support Evaluation of Clinical Decision Support Systems Systems  Computing techniques used to create DSS Computing techniques used to create DSS  Design Cycle for the development of DSS Design Cycle for the development of DSS  Early AI/Decision Support Systems. Early AI/Decision Support Systems.  Open source Example Open source Example CDSS-3 CSE 300 Scope of Clinical Decision Support Systems Scope of Clinical Decision Support Systems  Definition Definition  Categories of CDSS Categories of CDSS  System Architecture System Architecture  Advantages / Need for CDSS Advantages / Need for CDSS  Applications Areas Applications Areas  Disadvantages Disadvantages CDSS-4 CSE 300 Definition Definition  A A clinical decision-support system clinical 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, any any 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-5 CSE 300 Categories Categories  Generating alerts and reminders Generating alerts and reminders  Diagnostic assistance Diagnostic assistance  Therapy critiquing and planning Therapy critiquing and planning  Image recognition and interpretation Image recognition and interpretation CDSS-6 CSE 300 Inference Engine Clinical Data Reposit o ry (CDR) User Knowledge Base Event Monitor Notifier Recipient(s) CDSS-7 CSE 300 Tools for Information Management Tools 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 apply apply that that information to a particular decision task information to a particular decision task (particular patient) (particular patient) CDSS-8 CSE 300 Tools for Focusing Attention Tools 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-9 CSE 300 Tools for Patient-Specific Consultation Tools 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-10 CSE 300 Alternative (more specific) Definition Alternative (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 advice [...]... Evaluation of User Needs Top management support Commitment of expert Integration Issues Human Computer Interface Incorporation of domain knowledge Consideration of social and organisational context of the CDSS CDSS-19 Evaluation of Clinical Decision Support Systems CSE 300   Criteria for success of CDSS Aspects for consideration during evaluation CDSS-20 Criteria for a clinically useful DSS CSE 300  ... validated rigorously CDSS-21 Criteria for a clinically useful DSS (cont.) CSE 300     System improves clinical practice Clinician is in control The system is easy to use The decisions made are transparent CDSS-22 Aspects for Evaluation of a CDSS CSE 300     The process used to develop the system The systems essential structure Evidence of accuracy, generality and clinical effectiveness The impact of... Reasoning Artificial Neural Networks Expert Systems - Knowledge based Methods  Rule based Systems CDSS-24 Design Cycle for the development of a CDSS CSE 300        Planning Phase Research Phase System Analysis and conceptual phase Design Phase Construction phase Further Development phase Maintenance, documentation and adaptation CDSS-25 Early AI /Decision Support Systems CSE 300  De Dombal's system... Systems CSE 300  De Dombal's system for acute abdominal pain (1972)     developed at Leeds University decision making was based on the naive Bayesian approach automated reasoning under uncertainty designed to support the diagnosis of acute abdominal pain CDSS-26 Early AI /Decision Support Systems CSE 300  INTERNIST-I (1974)     rule-based expert system designed at the University of Pittsburgh...Characterizing Decision- Support Systems CSE 300  System function    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 advice   Passive role (physician uses the system when advice needed) Active role (the system gives advice automatically under certain conditions) CDSS-11 Passive Systems. .. disease states used as a basis for successor systems including CADUCEUS and Quick Medical Reference (QMR) CDSS-27 Example: Decision Tree 1 CSE 300 CDSS-28 Example: Decision Tree 2 CSE 300 CDSS-29 CSE 300  MYCIN (1976)   rule-based expert system designed to diagnose and recommend treatment for certain blood infections (extended to handle other infectious diseases) Clinical knowledge in MYCIN is represented... certainty factors attached to diagnoses CDSS-30 Example: Decision Rule 1 CSE 300 CDSS-31 System MYCIN – a Decision Rule CSE 300 CDSS-32 System MYCIN – Explanation Example CSE 300 CDSS-33 System HELP – MLM Example CSE 300 CDSS-34 System ONCOCIN – Cancer-Treatment Protocol Example CSE 300 CDSS-35 Successful CDS Systems CSE 300  DXplain    uses a set of clinical findings (signs, symptoms, laboratory data)... internal medicine  Examples: QMR, DXPLAIN  Narrow domain  Acute abdominal pain  Analysis of ECG CDSS-12 Passive Systems (cont.) CSE 300  Characteristics:   Stand-alone Data entry:  System initiative  User initiative  Consultation style  Consulting model  Critiquing model CDSS-13 Active Systems CSE 300  The user has partial control     System gives advice User evaluates the advice The user... the advice The user accepts/rejects the advice Domain of use  Limited domain     Drug interactions Protocol conformance control Laboratory results warnings Medical devices control CDSS-14 Active Systems (cont.) CSE 300  Characteristics   Data entry    By the user Related to the main application Consultation style   Built-in/integrated with other system (e.g laboratory information system,... reminders, therapy) CARE (reminders) CDSS-15 Need for CDSS CSE 300  Limited resources - increased demand Physicians are overwhelmed   Insufficient time available for diagnosis and treatment Need for systems that can improve health care processes and their outcomes in this scenario CDSS-16 Application Areas CSE 300 CDSS-17 Possible Disadvantages of CDSS CSE 300    Changing relation between patient . CDSS-1 CSE 300 Clinical Decision Support Systems Clinical Decision Support Systems Mohammed Saleem Mohammed Saleem CDSS-2 CSE 300 Overview Overview  Scope of Clinical Decision Support Systems Scope. of Clinical Decision Support Systems  Issues for success or failure Issues for success or failure  Evaluation of Clinical Decision Support Evaluation of Clinical Decision Support Systems Systems  Computing. AI /Decision Support Systems. Early AI /Decision Support Systems.  Open source Example Open source Example CDSS-3 CSE 300 Scope of Clinical Decision Support Systems Scope of Clinical Decision