Mobilizing clinical decision support to facilitate knowledge translation: A case study in China

2015 ◽  
Vol 60 ◽  
pp. 40-50 ◽  
Author(s):  
Yinsheng Zhang ◽  
Haomin Li ◽  
Huilong Duan ◽  
Yinhong Zhao
2020 ◽  
Vol 142 ◽  
pp. 104196
Author(s):  
Julie N. Babione ◽  
Wrechelle Ocampo ◽  
Sydney Haubrich ◽  
Connie Yang ◽  
Torre Zuk ◽  
...  

2020 ◽  
Author(s):  
azita yazdani ◽  
Reza Safdari ◽  
Roxana Sharifian ◽  
maryam zahmatkeshan

Abstract Background: One of the most important types of information systems that play important role today in providing quality health care services are clinical decision support systems (CDSSs). These systems are effective in overcoming human resource constraint and intelligent analysis of information generated by Tele-monitoring systems. In spite of the many advantages of this architectures, these are single-purpose, meaning that only the CDSS of a disease is located on them. If we want to use the same model of architecture in the decision-making process of another disease, all the components of this architecture should be redevelopment with a new CDSS, which is time-consuming and costly. Due to the increasing demand for health information technology at low cost and mobile access in the health care industry, in this article, a scalable software platform(Patient Tele monitoring: PATEL) based on SOA for implementing and use different CDSSs on a common platform, for use in Tele-monitoring Systems, was created.Implementation: To develop PATEL platform, the component-based software development approach and hybrid programming approach to implementing various components used. In the evaluation phase of the proposed platform, the case study, accuracy and performance evaluation (transmission delays, patient data fetch, parsing overhead and inference time) used.Results: The results of the case study evaluation confirmed the scalability and interoperability between CDSSs on the platform. Based on performance evaluation, the proposed platform has responded to 89% of the requests in less than one second. Also, based on accuracy evaluation, the platform presented in this article was successful in diagnosing 91.6% of the cases.Conclusion: The proposed platform can support CDSSs of various diseases simultaneously and provides the necessary scalability to add a new CDSS. Tele-monitoring systems will be capable of service by connecting to this platform. Using this infrastructure is expected to be a lot of duplication in the implementation of tele-monitoring systems based CDSSs will be reduced.


2019 ◽  
Vol 10 (02) ◽  
pp. 237-246 ◽  
Author(s):  
Jeritt Thayer ◽  
Jeffrey Miller ◽  
Alexander Fiks ◽  
Linda Tague ◽  
Robert Grundmeier

Background With the widespread adoption of vendor-supplied electronic health record (EHR) systems, clinical decision support (CDS) customization efforts beyond those anticipated by the vendor may require the use of technologies external to the EHR such as web services. Pursuing such customizations, however, is not without risk. Validating the expected behavior of a customized CDS system in the high-volume, complex environment of the live EHR is a challenging problem. Objective This article identifies technology failures that impacted clinical care related to web service-based advanced custom CDS systems embedded in the complex sociotechnical context of a production EHR. Methods In an academic health system’s primary care network, we performed an inventory of incidents between January 1, 2008 and December 31, 2016 related to a customized CDS system and performed a targeted review of changes in the CDS source code. Additional feedback on the root cause of individual incidents was obtained through interviews with members of the CDS project teams. Results We identified five CDS malfunctions that impaired clinical workflow. The mechanisms for these failures are mapped to four characteristics of well-behaved applications: (1) system integrity; (2) data integrity; (3) reliability; and (4) scalability. Over the 9-year period, two malfunctions of the customized CDS significantly impaired clinical workflow for a total of 5 hours. Lesser impacts—loss of individual features with straightforward workarounds—arose from three malfunctions, which affected users on 53 days. Discussion Advanced customization of EHRs for the purpose of CDS can present significant risks to clinical workflow. Conclusion This case study highlights that advanced customization of CDS within a commercial EHR may support care for complex patient populations, but ongoing monitoring and support is required to ensure its safe use.


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