Clinical Decision Support Systems (CDSS) for preventive management of COPD patients

Abstract

BackgroundThe use of information and communication technologies to manage chronic diseases allows the application of integrated care pathways, and the optimization and standardization of care processes. Decision support tools can assist in the adherence to best-practice medicine in critical decision points during the execution of a care pathway.ObjectivesThe objectives are to design, develop, and assess a clinical decision support system (CDSS) offering a suite of services for the early detection and assessment of chronic obstructive pulmonary disease (COPD), which can be easily integrated into a healthcare providers' work-flow.MethodsThe software architecture model for the CDSS, interoperable clinical-knowledge representation, and inference engine were designed and implemented to form a base CDSS framework. The CDSS functionalities were iteratively developed through requirement-adjustment/development/validation cycles using enterprise-grade software-engineering methodologies and technologies. Within each cycle, clinical-knowledge acquisition was performed by a health-informatics engineer and a clinical-expert team.ResultsA suite of decision-support web services for (i) COPD early detection and diagnosis, (ii) spirometry quality-control support, (iii) patient stratification, was deployed in a secured environment on-line. The CDSS diagnostic performance was assessed using a validation set of 323 cases with 90% specificity, and 96% sensitivity. Web services were integrated in existing health information system platforms.ConclusionsSpecialized decision support can be offered as a complementary service to existing policies of integrated care for chronic-disease management. The CDSS was able to issue recommendations that have a high degree of accuracy to support COPD case-finding. Integration into healthcare providers' work-flow can be achieved seamlessly through the use of a modular design and service-oriented architecture that connect to existing health information systems.

How to Define Pathogenicity, Health, and Disease?

“…PMs could be integrated with other information to build clinical diagnosis support systems, which are already implemented in some areas [Samarghitean and Vihinen, ; Velickovski et al. ; Jabez Christopher et al. ].…”

“…PMs could be integrated with other information to build clinical diagnosis support systems, which are already implemented in some areas [Samarghitean and Vihinen, 2008;Velickovski et al 2014;Jabez Christopher et al 2015]. In addition to the diagnostic level of pathogenicity, additional thresholds could be implemented.…”

Modeling the Construct of an Expert Evidence-Adaptive Knowledge Base for a Pressure Injury Clinical Decision Support System

“…The argument for decisions in wound treatment were expressed using these classes (wound-bed appearance, stage, exudate level, treatment, frequency, cleansing solution, and instructions), and their variables using rule-based reasoning logical operations of IF-AND-THEN model in the order of antecedent-to-consequent actions [4,10]. The selection of IF and AND corresponded with the wound attributes (wound-bed appearance, stage, exudate level, and classification), and served as the "antecedents" (input).…”

“…An iterative and incremental development for a comprehensive CDSS is adopted, which could support knowledge-based reasoning for chronic-wound management [10,20]. The study project started with the construct of only the PI-CDSS.…”

Clinical decision support system as a risk assessment tool to aid in earlier diagnosis of pancreatic cancer

“…Studies have reported the effectiveness of utilizing CDSS in health conditions such as asthma 30 , chronic obstructive pulmonary disease 31 , pain therapy 32 , cardiovascular disease 33 , breast cancer detection 34 and a host of other health conditions with the exception of pancreatic cancer. The notion of CDSS has been around for the past 30 years however, implementation and acceptance of using CDSS in health care settings are still at the bare minimum.…”