Testing an individualized digital decision assist system for the diagnosis and management of mental and behavior disorders in children and adolescents

Abstract

Background Nearly half of all mental health disorders develop prior to the age of 15. Early assessments, diagnosis, and treatment are critical to shortening single episodes of care, reducing possible comorbidity and long-term disability. In Norway, approximately 20% of all children and adolescents are experiencing mental health problems. To address this, health officials in Norway have called for the integration of innovative approaches. A clinical decision support system (CDSS) is an innovative, computer-based program that provides health professionals with clinical decision support as they care for patients. CDSS use standardized clinical guidelines and big data to provide guidance and recommendations to clinicians in real-time. IDDEAS (Individualised Digital DEcision Assist System) is a CDSS for diagnosis and treatment of child and adolescent mental health disorders. The aim of IDDEAS is to enhance quality, competency, and efficiency in child and adolescent mental health services (CAMHS). Methods/design IDDEAS is a mixed-methods innovation and research project, which consists of four stages: 1) Assessment of Needs and Preparation of IDDEAS; 2) The Development of IDDEAS CDSS Model; 3) The Evaluation of the IDDEAS CDSS; and, 4) Implementation & Dissemination. Both qualitative and quantitative methods will be used for the evaluation of IDDEAS CDSS model. Child and adolescent psychologists and psychiatrists (n = 30) will evaluate the IDDEAS` usability, acceptability and relevance for diagnosis and treatment of attention-deficit/hyperactivity disorder. Discussion The IDDEAS CDSS model is the first guidelines and data-driven CDSS to improve efficiency of diagnosis and treatment of child and adolescent mental health disorders in Norway. Ultimately, IDDEAS will help to improve patient health outcomes and prevent long-term adverse outcomes by providing each patient with evidence-based, customized clinical care. Trial registration ISRCTN, ISRCTN12094788. Ongoing study, registered prospectively 8 April 2020 10.1186/ISRCTN12094788

Local, Early, and Precise: Designing a Clinical Decision Support System for Child and Adolescent Mental Health Services

“…The complexities of a CDSS for CAMHS have all come under consideration in the development of the Individualized Digital DEcision Assist System (IDDEAS) project. IDDEAS, an innovation and research project in Norway, aims to design and implement a CDSS that can support the diagnoses and treatment of mental health disorders in children and adolescents, starting with ADHD as the first model clinical paradigm ( 50 , 51 ). With nearly 4% of all 12 year olds in Norway having ADHD at any point in time ( 7 ), the disorder will serve as the first case example for IDDEAS.…”

“…Data representing multiple episodes of care for different patients are structured into domains of inter-related concepts and hierarchical clinical patterns. They are then ranked within the system, matched with the current patient and ultimately provided within the system's interface to support the practitioner through clinical decision making ( 50 , 51 ). In addition, guidelines and other clinical recommendations are compiled and encoded before being combined with the data-driven trajectories and patterns to provide ranked suggestions in response to any practitioner queries ( 50 , 51 ).…”

“…They are then ranked within the system, matched with the current patient and ultimately provided within the system's interface to support the practitioner through clinical decision making ( 50 , 51 ). In addition, guidelines and other clinical recommendations are compiled and encoded before being combined with the data-driven trajectories and patterns to provide ranked suggestions in response to any practitioner queries ( 50 , 51 ). By designing a CDSS that utilizes both guidelines and big data, the system has the potential to be curated based on evolving scientific evidence, and with the use of each individual patient's own EHR data to also build upon the available evidence base within the system ( 51 ).…”

“… The IDDEAS clinical decision support system model. This figure is adapted from ( 50 ) which was published under the CC BY 4.0 license ( https://creativecommons.org/licenses/by/4.0/ ). It has been slightly revised to reflect architecture development.…”

“…The IDDEAS CDSS will be designed and evaluated in iterations. As this approach to CDSS design for CAMHS is relatively novel, to ensure IDDEAS is usable and appropriate for clinicians and patients, all iterations will be conducted collaboratively among the technical and clinical experts of the IDDEAS Consortium ( 50 ). With IDDEAS being an innovation project, each stage will build upon the previous one, with first identifying the needs of practitioners and assessing the perceived usability of the prototype system before going on to investigate the utility and efficacy of the system to care for real patients ( 50 ).…”