Contributions on Clinical Decision Support from the 2018 Literature

Abstract

Objectives: To summarize recent research and select the best papers published in 2018 in the field of computerized clinical decision support for the Decision Support section of the International Medical Informatics Association (IMIA) yearbook. Methods: A literature review was performed by searching two bibliographic databases for papers referring to clinical decision support systems (CDSSs). The aim was to identify a list of candidate best papers from the retrieved bibliographic records, which were then peer-reviewed by external reviewers. A consensus meeting of the IMIA editorial team finally selected the best papers on the basis of all reviews and the section editors' evaluation. Results: Among 1,148 retrieved articles, 15 best paper candidates were selected, the review of which resulted in the selection of four best papers. The first paper introduces a deep learning model for estimating short-term life expectancy (>3 months) of metastatic cancer patients by analyzing free-text clinical notes in electronic medical records, while maintaining the temporal visit sequence. The second paper takes note that CDSSs become routinely integrated in health information systems and compares statistical anomaly detection models to identify CDSS malfunctions which, if remain unnoticed, may have a negative impact on care delivery. The third paper fairly reports on lessons learnt from the development of an oncology CDSS using artificial intelligence techniques and from its assessment in a large US cancer center. The fourth paper implements a preference learning methodology for detecting inconsistencies in clinical practice guidelines and illustrates the applicability of the proposed methodology to antibiotherapy. Conclusions: Three of the four best papers rely on data-driven methods, and one builds on a knowledge-based approach. While there is currently a trend for data-driven decision support, the promising results of such approaches still need to be confirmed by the adoption of these systems and their routine use.

An Integrated Process for Co-Developing and Implementing Written and Computable Clinical Practice Guidelines

“…Recent evidence shows promising results of CDS systems combined with the integration of computable CPGs into clinical workflows to further improve patient care and health outcomes. 27 , 28 , 88 Although CDS systems have been shown to improve health care process measures related to decision-making, diagnostic accuracy, and appropriate testing across diverse settings, effects on clinical and economic outcomes remain sparse. 18 …”

“… 18 Furthermore, the integration of computable CPGs into clinical workflows via CDS requires additional evaluation to assure that patient care and health outcomes will be improved. 27 , 28 …”

Proposal for a Standard Architecture for the Integration of Clinical Information Systems in a Complex Hospital Environment

“…From an operational point of view, the practical applications of the architecture are broad. These include complex analysis and operational systems where the use of heterogeneous data is critical for decision support systems (DSSs) in clinical environments [25].…”

Pragmatic Considerations on Clinical Decision Support from the 2019 Literature

“…Both databases were searched with similar queries, tailored to the specificities of each one, targeting journal articles published in 2019, written in English, and related to the aforementioned topics. The adopted strategy was the same as that used in prior years [2] and is based on four exclusive queries that return four disjoint citation subsets. The first query (Q Pub_plain ) is based on a plain-text search in PubMed titles and abstracts using keywords.…”