Clinical Decision Support: a 25 Year Retrospective and a 25 Year Vision.
Clinical Decision Support: a 25 Year Retrospective and a 25 Year Vision.
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DOI：
10.15265/iys-2016-s034
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发表时间：
2016-08-02
影响因子：
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通讯作者：
Wright, A
中科院分区：
文献类型：
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作者：
Middleton, B;Sittig, D F;Wright, A
目的：本综述的目的是总结1990年左右临床决策支持(CDS)的技术现状，回顾从那时起25年间的进展，并展望25年后或2040年左右CDS可能是什么样子。方法：非正式的医学文献综述，作者之间反复回顾和讨论，以达到六个轴(数据、知识、推理、架构和技术、实施和集成，以及用户)，以架构对CDS有效使用的选定障碍和促进器的审查和讨论。随着数据可用性的提高，在组织和编码标准化数据方面的关键进展，CDS知识库的发展，以及共享知识构件能力的提高，从临床数据分析和推断的方法的爆炸，促进CDS广泛应用的信息技术和体系结构的发展，实施CDS的方法的改进和将CDS集成到临床工作流程中，以及最终用户的日益复杂，所有这些都在提高CDS在医疗服务中的有效使用方面发挥了作用。结论：CDS在过去25年中发生了巨大的变化，并可能在未来25年内同样显著地或更快地发展。越来越多地，临床医生和患者之间的临床接触将得到各种各样的认知助手的支持，以支持诊断、治疗、护理协调、监测和预防以及健康维护或健康。
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.