Evolving Clinical Information Libraries: Contextualizing Evidence Based Medicine

描述（由申请人提供）： 我们建议规划一个基于背景的医学范式，在这个范式中，循证医学决策的基础不仅包括传统的已发表的医学知识，还包括来自高度加工的临床、环境和流行病学信息的证据。目前，这样的环境上下文信息很少可用，或者最多只能由做出护理决策的提供者和患者非正式地使用。正在形成的国家卫生信息网络为跨机构和跨学科向决策者提供适合具体情况的信息创造了理想的机会。 该提案的目标是支持NLM长期计划所称的21世纪智能健康系统。其目标是支持，在整个哈佛医疗机构，推理，诊断和临床预测，通过正规化的数字图书馆基础设施，以促进收购，处理和交付的高度加工，有用的知识，从临床护理网站，公共卫生当局，图书馆和病人在家里。我们将概念化和规划一个情境化的临床护理信息资源（C3 IR），将个人，环境和人口数据与临床和个人行动联系起来，通过电子健康记录和/或个人控制的健康记录向临床医生提供解释和定制的信息，并通过个人控制的健康记录向个人提供信息。我们将围绕四个示例性用例来规划和开发这个新颖的图书馆服务。我们的计划是建立一个工作模式，以服务于哈佛医学界和凝聚一个学习社区的机构和个人用户的进步，完善和发展的情境循证医学。

DESCRIPTION (provided by applicant): We propose planning for a paradigm of context based medicine, in which the basis for making evidence-based medical decisions includes not only traditional published medical knowledge but also evidence from highly processed clinical, environmental, and epidemiological information. Currently, such ambient contextual information is rarely available or at best used only informally by providers and patients making care decisions. The emerging national health information network creates an ideal opportunity for delivering context- appropriate information to decision makers, across institutions and disciplines. The goal of this proposal is to support what the NLM Long Range Plan calls a 21st century intelligent health system. The objective is to support, across Harvard healthcare institutions, inference, diagnosis and clinical prediction by formalizing a digital library infrastructure to facilitate acquisition, processing and delivery of highly processed, usable knowledge from clinical care sites, public health authorities, libraries and patients at home. We will conceptualize and plan a Contextualized Clinical Care Information Resource (C3IR) that links personal, environmental and population data to clinical and personal action by delivering interpreted and tailored information to clinicians through electronic health records and/or personally controlled health records and to individuals through personally controlled health records, at the point of decision. We will ground the planning and development process for this novel library service around four exemplary use cases. Our plan is to build a working model to serve the Harvard Medical community and cohere a learning community of institutional and individual users in the advancement, refinement and development of contextualized evidence based medicine.