Evolving Clinical Information Libraries: Contextualizing Evidence Based Medicine

描述(由申请人提供)： 我们建议规划一种基于背景的医学范式，其中做出循证医学决策的基础不仅包括传统的已发表医学知识，还包括来自高度处理的临床、环境和流行病学信息的证据。目前，这种环境背景信息很少获得，或者充其量只能由提供者和患者非正式地使用，以做出护理决策。新兴的国家卫生信息网络为跨机构和学科向决策者提供切合实际的信息创造了一个理想的机会。 这项提案的目标是支持NLM长期计划所称的21世纪智能医疗系统。其目标是通过正规化数字图书馆基础设施来支持整个哈佛医疗机构的推理、诊断和临床预测，以促进从临床护理站点、公共卫生当局、图书馆和患者家中获取、处理和交付经过高度处理的有用知识。我们将构思并计划一个情境化的临床护理信息资源(C3IR)，通过在决策点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解释和定制的信息，将个人、环境和人口数据与临床和个人行动联系起来。我们将围绕四个示范用例来规划和开发这项新的图书馆服务。我们的计划是建立一个服务于哈佛医学界的工作模式，并在循证医学的发展、改进和发展中凝聚机构和个人用户的学习社区。

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.