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

BACKGROUND A wide gulf remains between knowledge and clinical practice. Clinical decision support has been demonstrated to be an effective knowledge tool that healthcare organizations can employ to deliver the "right knowledge to the right people in the right form at the right time". How to adopt various clinical decision support (CDS) systems efficiently to facilitate evidence-based practice is one challenge faced by knowledge translation research. METHOD A computer-aided knowledge translation method that mobilizes evidence-based decision supports is proposed. The foundation of the method is a knowledge representation model that is able to cover, coordinate and synergize various types of medical knowledge to achieve centralized and effective knowledge management. Next, web-based knowledge-authoring and natural language processing based knowledge acquisition tools are designed to accelerate the transformation of the latest clinical evidence into computerized knowledge content. Finally, a batch of fundamental services, such as data acquisition and inference engine, are designed to actuate the acquired knowledge content. These services can be used as building blocks for various evidence-based decision support applications. RESULTS Based on the above method, a computer-aided knowledge translation platform was constructed as a CDS infrastructure. Based on this platform, typical CDS applications were developed. A case study of drug use check demonstrates that the CDS intervention delivered by the platform has produced observable behavior changes (89.7% of alerted medical orders were revised by physicians). DISCUSSION Computer-aided knowledge translation via a CDS infrastructure can be effective in facilitating knowledge translation in clinical settings.

[1]  Charles P. Friedman,et al.  Viewpoint Paper: A "Fundamental Theorem" of Biomedical Informatics , 2009, J. Am. Medical Informatics Assoc..

[2]  B Middleton,et al.  Ambulatory practice clinical information management: problems and prospects. , 1997, Healthcare information management : journal of the Healthcare Information and Management Systems Society of the American Hospital Association.

[3]  David W. Bates,et al.  Design and implementation of a comprehensive outpatient Results Manager , 2003, J. Biomed. Informatics.

[4]  F. Mosteller,et al.  A comparison of results of meta-analyses of randomized control trials and recommendations of clinical experts. Treatments for myocardial infarction. , 1992, JAMA.

[5]  Ranjit Bose,et al.  Knowledge management-enabled health care management systems: capabilities, infrastructure, and decision-support , 2003, Expert Syst. Appl..

[6]  José A. Blakeley,et al.  Anatomy of the ADO.NET entity framework , 2007, SIGMOD '07.

[7]  Paul Browne,et al.  JBoss Drools Business Rules , 2009 .

[8]  B. Haynes.  Of studies, syntheses, synopses, summaries, and systems: the “5S” evolution of information services for evidence-based healthcare decisions , 2007, Evidence-based medicine.

[9]  M Stefanelli,et al.  Knowledge and Process Management in Health Care Organizations , 2004, Methods of Information in Medicine.

[10]  R. Grol.  Successes and Failures in the Implementation of Evidence-Based Guidelines for Clinical Practice , 2001, Medical care.

[11]  Guilherme Del Fiol,et al.  Implementations of the HL7 Context-Aware Knowledge Retrieval ("Infobutton") Standard: Challenges, strengths, limitations, and uptake , 2012, J. Biomed. Informatics.

[12]  C. Hanson.  Healthcare Informatics , 2005 .

[13]  Michel Dojat,et al.  Application of Information Technology: A UMLS-based Knowledge Acquisition Tool for Rule-based Clinical Decision Support System Development , 2001, J. Am. Medical Informatics Assoc..

[14]  Paul G Shekelle,et al.  Delivery of genomic medicine for common chronic adult diseases: a systematic review. , 2008, JAMA.

[15]  Orrin I. Franko,et al.  Smartphone App Use Among Medical Providers in ACGME Training Programs , 2012, Journal of Medical Systems.

[16]  Michel Dojat,et al.  Knowledge acquisition environment for the design of a decision support system: application in blood transfusion , 1999, AMIA.

[17]  Felix W Frueh,et al.  From pharmacogenetics to personalized medicine: a vital need for educating health professionals and the community. , 2004, Pharmacogenomics.

[18]  Thomas H. Payne,et al.  Review Paper: Medication-related Clinical Decision Support in Computerized Provider Order Entry Systems: A Review , 2007, J. Am. Medical Informatics Assoc..

[19]  Omolola Ogunyemi,et al.  Toward a Representation Format for Sharable Clinical Guidelines , 2001, J. Biomed. Informatics.

[20]  E. Reed,et al.  Clinical Utility of Microarrays: Current Status, Existing Challenges and Future Outlook , 2008, Current genomics.

[21]  L. Hayden,et al.  Ten Commandments for Effective Clinical Decision Support: Making the Practice of Evidence-based Medicine a Reality , 2011 .

[22]  S Tu,et al.  Section 5: Decision Support, Knowledge Representation and Management: Decision Support, Knowledge Representation and Management in Medicine , 2006, Yearbook of Medical Informatics.

[23]  Diane L. Seger,et al.  Adverse Drug Event Rates in Six Community Hospitals and the Potential Impact of Computerized Physician Order Entry for Prevention , 2009, Journal of General Internal Medicine.

[24]  J Lomas,et al.  Diffusion, Dissemination, and Implementation: Who Should Do What? , 1993, Annals of the New York Academy of Sciences.

[25]  Jacqueline Tetroe,et al.  Knowledge Translation at the Canadian Institutes of Health Research: A Primer , 2007 .

[26]  Jihoon Kim,et al.  A multi-layered framework for disseminating knowledge for computer-based decision support , 2011, J. Am. Medical Informatics Assoc..

[27]  Odysseas Hirakis,et al.  Goals and Benefits of Knowledge Management in Healthcare , 2006 .

[28]  Walter V. Sujansky,et al.  Heterogeneous Database Integration in Biomedicine , 2001, J. Biomed. Informatics.

[29]  D. Sackett,et al.  Evidence based medicine: what it is and what it isn't , 1996, BMJ.

[30]  Katherine A. Sward,et al.  Executing medical logic modules expressed in ArdenML using Drools , 2012, J. Am. Medical Informatics Assoc..

[31]  Guus Schreiber,et al.  Knowledge Engineering and Management: The CommonKADS Methodology , 1999 .

[32]  Alissa L. Russ,et al.  A Human Factors Investigation of Medication Alerts: Barriers to Prescriber Decision-Making and Clinical Workflow , 2009, AMIA.

[33]  R. Haynes,et al.  Effects of Computer-based Clinical Decision Support Systems on Clinician Performance and Patient Outcome: A Critical Appraisal of Research , 1994, Annals of Internal Medicine.

[34]  P. Basch.  Quality of health care delivered to adults in the United States. , 2003, New England Journal of Medicine.

[35]  P. Shekelle,et al.  Validity of the Agency for Healthcare Research and Quality clinical practice guidelines: how quickly do guidelines become outdated? , 2001, JAMA.

[36]  A. Gittelsohn,et al.  Small Area Variations in Health Care Delivery , 1973, Science.

[37]  Monique W. M. Jaspers,et al.  Effects of clinical decision-support systems on practitioner performance and patient outcomes: a synthesis of high-quality systematic review findings , 2011, J. Am. Medical Informatics Assoc..

[38]  A. Sloman.  Why We Need Many Knowledge Representation Formalisms , 2022 .

[39]  B. Haynes.  Of studies, syntheses, synopses, summaries, and systems: the "5S" evolution of information services for evidence-based healthcare decisions. , 2006, Evidence-based nursing.

[40]  Peter L. Elkin,et al.  The introduction of a diagnostic decision support system (DXplainTM) into the workflow of a teaching hospital service can decrease the cost of service for diagnostically challenging Diagnostic Related Groups (DRGs) , 2010, Int. J. Medical Informatics.

[41]  H. Lehmann,et al.  Clinical Decision Support Systems (cdsss) Have Been Hailed for Their Potential to Reduce Medical Errors Clinical Decision Support Systems for the Practice of Evidence-based Medicine , 2022 .

[42]  Marie-Joy Paredes.  Health care information technology. , 2008, Issue brief.

[43]  V. Hasselblad,et al.  Effect of Clinical Decision-Support Systems , 2012, Annals of Internal Medicine.

[44]  Duan Huilong,et al.  An Integration Approach of Healthcare Information System , 2008, 2008 International Conference on BioMedical Engineering and Informatics.

[45]  Russell W. Quong,et al.  ANTLR: A predicated‐LL(k) parser generator , 1995, Softw. Pract. Exp..

[46]  Chunhua Weng,et al.  Formal representation of eligibility criteria: A literature review , 2010, J. Biomed. Informatics.

[47]  Jens H. Weber,et al.  A Light-Weight Component for Adding Decision Support to Electronic Medical Records , 2008, Proceedings of the 41st Annual Hawaii International Conference on System Sciences (HICSS 2008).