临床决策支持 Planning EON Asgaard.pptVIP

Medical Decision-Support Systems Automated Support toGuideline-Based CareYuval Shahar, M.D., Ph.D. Clinical Guidelines A standard of care, typically an experts’ consensus Usually specifies diagnostic and therapeutic procedures Also known as clinical protocols (e.g., in oncology); care plans A powerful method to standardize and improve the quality of medical care [Grimshaw and Russel, 1993]. Increasingly widespread use, to spur best practices in medical care and to incorporate evidence-based medicine Computer-based techniques needed to automated the support of guideline-oriented medical care. Example tasks to be supported: determining the applicability of a guideline for a given patient, monitoring the application of the guideline, assessing the effectiveness of the guideline Characteristics of Automated Support toGuideline-Based Care Dialog: Care provider automated support system Both have relative strengths: Care provider: Better access to patient data and to medical knowledge Automated system: Better access to guidelines and to temporal patterns The aim is synergy Automated Support for Clinical Guidelines: Prescriptive approaches DILEMMA, PRESTIGE, Proforma (UK/EU) Oncocin, T-Helper, EON (Stanford) Arden Syntax/MLMs (Columbia/LDS) GEODE-CM (Harvard: Brigham and Women’s) MTBA (Harvard: Massachusetts General) GLIF (Columbia, Harvard, Stanford): Attempts to capture and share the best of EON, MLMs, GEODE-CM, MTBA Automated Support for Clinical Guidelines: Critiquing Approaches VT-Attending (Miller, Yale) HyperCritique (Van der Lei and Musen, Rotterdam) The Asgaard project (Stanford, Vienna, London) integrates both prescriptive and critiquing approaches by representing both the prescribed default actions and the underlying process and outcome intentions Requirements for Automated Protocol-Based Care Ability to deal with complexity of patient data (e.g., time dependencies, abstractions, missing data) Ability to deal with compl