Clinical Decision Support systems for Evidence Based Medicine Practice

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Define the major components of a Clinical Decision-Support System.

Clinical decision support system (CDSS) is defined as software that is designed to be a direct aid to clinical decision-making, in which the characteristics of an individual patient are matched to a computerized clinical knowledge base and patient-specific assessments or recommendations are then presented to the clinician or the patient for a decision.( Sim et al, 2001 )

The design and implementation of a successful Clinical Decision Support system(CDSS) is a complex undertaking.

The CDSS at the Regenstrief Institute incorporates sophisticated systems and is one of the oldest and most successful in the U.S(Friedlin et al,2007). The well established, successful system can served as a template or model for the future development of similar systems. The components of the CDSS at Regenstrief , is described below:

The CDS system at Regenstrief consists of a series of interrelated but distinct rules written in the G-CARE language.
All rules, regardless of type, contain the same structure. Information common to all rules includes rule name, type, author, date of rule creation/modification, rule duration, and the names of other rules which use this rule (rule ancestors) as well as the names of other rules this rule uses (rule daughters). Most rules also contain one or more logic sections, which are expressions that are evaluated to output either a specific value, a date, or a Boolean (True/False) value. The results of this expression are used by other rules that contain this rule in their logic. Most rules also contain rule exclusion criteria which if true, prevent the rules' logic from evaluating. A rules' duration or 'life span' determines when the rule should be re-evaluated. For example, the duration for the rule which determines a patient's race is forever, while the rule which calculates the last potassium level is one day. Each reminder rule display message also can be assigned a guideline text pointer which is an index to full text clinical guidelines. The rules in theCDS system are arranged in a complex hierarchical structure. Highest level reminder rules will only evaluate to true if intermediate rules lower in the hierarchy are also true, which in turn will only evaluate to true if the lowest level 'building block' rules are also true.

In the system, reminder rules can be triggered in four different ways: 1) the passage of time (such as flu shot reminders), 2) the entry of a patient problem or diagnosis (a diagnosis of deep vein thrombosis may trigger a reminder for heparin) 3) the entry of a diagnostic test (an order for a sigmoidoscopy may trigger a reminder that colonoscopy is the preferred test) 4) the entry of a treatment (an order for gentamicin triggers a reminder for gentamicin levels). Some reminder rules use the results of other reminder rules in their logic.
Most reminder rules contain multiple logic sections and are capable of displaying a unique message for each logic section that fires. Execution of a reminder rule proceeds through each logic section until the ...