Using a GuidelineCentered Approach for the Design of a使用指南为中心的方法设计一个。.pptVIP

Using a Guideline-Centered Approach for the Design of a Clinical Decision Support System to Promote Smoking Cessation Richard N. Shiffman, MD, MCIS George Michel, MS Abdelwaheb Essaihi, MD Theodore W. Marcy, MD, MPH Yale Center for Medical informatics University of Vermont College of Medicine Knowledge Acquisition from Guidelines:What’s the Problem? Ambiguity; guideline terms often lack explicit definitions Incomplete specification Additional knowledge is always necessary to create a decision support tool Creation of DSS KB risks error Local adaptation (necessary) risks preservation of habit, self interest Knowledge maintenance is a largely unaddressed but critical issue Representation of Guideline Knowledge for Decision Support Members of the InterMed Collaboratory encoded representations of guidelines for vaccination and workup of breast masses Tested with patient scenarios Different recommendations were given for the same patient Guideline Implementation Gap Goal (Intention) of This WorkOverview of Presentation Articulate a systematic, explicit, and transparent process for translating GL knowledge into DS tools GEM Overview Handheld, wireless DSS (under construction) for smoking cessation Advantages of Document-Centered DSS Design Preservation of authenticity of knowledge Audit of local adaptation (knowledge modifications) Diminished variability of DSS designs GEM Element Sources GEM: Top Levels Knowledge Components Conditional GEM Cutter Maintaining Links to Guideline Text Each GEM element has a unique identifier attribute a source attribute: default value is “explicit” changes to “inferred” if content is modified GEM Polishing Select (GL Rec) Semantic Refinement (Markup) Atomize De-abstract Disambiguate Verify completeness Build executables Smoking Cessation Cigarette smoking is most common cause of preventable death in the US Cessation can dramatically reduce risk of cancer and other diseases Smokers are more likely to quit if physicians counsel them P