Comp5 Unit7c Lecture Slides

History of Health Information Technology in the U.S.History of Clinical Decision

Support SystemsLecture c – Evolution of CDS

This material Comp5_Unit7 was developed by The University of Alabama Birmingham, funded by the Department of Health and Human Services, Office of the National Coordinator for Health Information Technology under Award Number 1U24OC000023

History of Clinical Decision Support Systems

Learning Objectives• Describe various types and structures of clinical decision support

(CDS) systems• Discuss the evolution of clinical decision support from expert

system research• Discuss the changes in focus of clinical decision support from the

1980s to the present• Discuss the change in architecture and mode of access of clinical

decision support systems from the 1980s to the present• Describe some of the early clinical decision support systems• Discuss the historical challenges in implementing CDS

2Health IT Workforce Curriculum Version 3.0/Spring 2012

History of Health Information Technology in the US History of Clinical Decision Support Systems Lecture c

Evolution of CDS

• Diagnostic and reminder CDS – 1980s to early 1990s

• Drug Interaction CDS– 1990s to Present

• Quality Indicator CDS– 2010 and beyond



Evolution of CDS Architecture

• Stand-alone systems

Source: (Wright & Sittig, 2008)




• Stand-alone systems • Integrated systems





• Stand-alone systems • Integrated systems• Standards-based systems





• Stand-alone systems • Integrated systems• Standards-based systems• Service models




Historical Challenges

• Funding for development




• Funding for development• Knowledge maintenance




• Funding for development• Knowledge maintenance• Optimal timing• Alert fatigue




• Funding for development• Knowledge maintenance• Optimal timing• Alert fatigue• Motivation for use• Lessons from history – 2 stories



History of the Blood Pressure Cuff

Crenner CW. Introduction of the blood pressure cuff into U.S. medical practice: technology and skilled practice. Ann Intern Med. 1998 Mar 15;128(6):488-93.



NASA/courtesy of nasaimages.org

History of the Blood Pressure Cuff



NASA/courtesy of nasaimages.org Photo by David Weiss

A Tale of Two Tugboats



Photo by George L. Smyth

The T.J. Hooper Decision

[A] whole calling may have unduly lagged in the adoption of new and available devices. It never may set its own tests, however persuasive be its usages. Courts must in the end say what is required; there are precautions so imperative that even their universal disregard will not excuse their omission. But here there was no custom at all as to receiving sets; some had them, some did not; the most that can be urged is that they had not yet become general. Certainly in such a case we need not pause; when some have thought a device necessary, at least we may say that they were right, and the others too slack.

Source: (Hand, 1932)



History of Clinical Decision Support Systems

Summary • Evolution of CDS architecture• Challenges to be overcome



Some of the material in this presentation is also included in the following and is used with permission:

Berner ES, La Lande TJ. Overview of CDSS. In: Berner ES, editor. Clinical decision support systems: theory and practice. 2nd ed., New York: Springer; 2007, p. 3-22.



History of Clinical DecisionSupport Systems

References – Lecture cReferences• Berner ES, La Lande TJ. Overview of CDSS. In: Berner ES, editor. Clinical decision support systems: theory and

practice. 2nd ed. New York: Springer; 2007. p. 3-22.• Crenner CW. Introduction of the blood pressure cuff into U.S. medical practice: technology and skilled practice.

Ann Intern Med. 1998 Mar 15;128(6):488-93.• Hand L. The T.J. Hooper, 60 F.2d 737, 740 (2d Cir. 1932).• Wright A, Sittig D. A four-phase model of the evolution of clinical decision support architectures. Int J Med Inform.

2008 Oct;77(10):641–9.

Images Slide 12, 13: Courtesy of NASA/nasaimages.org Available from:

http://images.jsc.nasa.gov/luceneweb/fullimage.jsp?from_month=9&from_day=1&from_year=1958&to_month=12&to_day=31&to_year=1996&datesearch=Go&pageno=2&captionpage=true&photoId=S61-02749&hitsperpage=100.

Slide 13: David Weiss, Personal Collection.Slide 14: George L. Smyth CC BY-NC-SA 2.0. Available from: http://www.flickr.com/photos/glsmyth/3097186351/.



http://images.jsc.nasa.gov/luceneweb/fullimage.jsp?from_month=9&from_day=1&from_year=1958&to_month=12&to_day=31&to_year=1996&datesearch=Go&pageno=2&captionpage=true&photoId=S61-02749&hitsperpage=100



http://www.flickr.com/photos/glsmyth/3097186351/

Documents

Comp5 Unit7c Lecture Slides