A 2014 medical informatics perspective on clinical decision support systems: do we hit the ceiling of effectiveness?
A 2014 medical informatics perspective on clinical decision support systems: do we hit the ceiling of effectiveness?
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DOI：
10.15265/iy-2014-0036
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发表时间：
2014-08-15
影响因子：
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通讯作者：
Lamy, J-B
中科院分区：
文献类型：
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作者：
Bouaud, J;Lamy, J-B
目的：总结最近的研究，并提出 2013 年在医疗保健计算机决策支持领域发表的最佳论文的选择。方法：两位编辑从书目数据库中进行了两篇文献综述，重点是临床决策支持系统 (CDSS) 和计算机提供商订单输入，以选择候选最佳论文列表，供外部评审员进行同行评审。结果：完整的评审过程突出了三篇论文，说明了该领域的当前趋势临床决策支持。第一个趋势是 CDSS 理论方法的发展，并以一篇提出将家族史和谱系整合到 CDSS 中的论文为例。第二个趋势是通过精心设计的 CDSS 来说明的，显示出良好的理论性能和接受度，但未能显示出临床影响。以一篇报告旨在减少药物不良事件的记分卡的论文为例。第三个趋势是试图了解 CDSS 使用局限性的研究工作，例如通过分析全科医生、患者和 CDSS 之间的相互作用。结论：CDSS 在敏感性和特异性方面可以取得良好的理论结果，并且获得良好的接受度，但评估往往无法证明临床影响。未来的研究需要更好地理解这一现象的原因，并为 CDSS 的实施设想新的有效解决方案。
OBJECTIVE: To summarize recent research and propose a selection of best papers published in 2013 in the field of computer-based decision support in health care.METHOD: Two literature reviews were performed by the two section editors from bibliographic databases with a focus on clinical decision support systems (CDSSs) and computer provider order entry in order to select a list of candidate best papers to be peer-reviewed by external reviewers.RESULTS: The full review process highlighted three papers, illustrating current trends in the domain of clinical decision support. The first trend is the development of theoretical approaches for CDSSs, and is exemplified by a paper proposing the integration of family histories and pedigrees in a CDSS. The second trend is illustrated by well-designed CDSSs, showing good theoretical performances and acceptance, while failing to show a clinical impact. An example is given with a paper reporting on scorecards aiming to reduce adverse drug events. The third trend is represented by research works that try to understand the limits of CDSS use, for instance by analyzing interactions between general practitioners, patients, and a CDSS.CONCLUSIONS: CDSSs can achieve good theoretical results in terms of sensibility and specificity, as well as a good acceptance, but evaluations often fail to demonstrate a clinical impact. Future research is needed to better understand the causes of this observation and imagine new effective solutions for CDSS implementation.