Clinical Decision Support Systems: Theory and Practice / Edition 2

by Eta S. Berner

Overview

This is a resource book on clinical decision support systems for informatics specialists, a textbook for teachers or students in health informatics and a comprehensive introduction for clinicians. It has become obvious that, in addition to physicians, other health professionals have need of decision support. Therefore, the issues raised in this book apply to a broad range of clinicians. The book includes chapters written by internationally recognized experts on the design, evaluation and application of these systems, who examine the impact of computer-based diagnostic tools both from the practitioner’s perspective and that of the patient.

Product Details

ISBN-13:	9780387339146
Publisher:	Springer New York
Publication date:	12/05/2008
Series:	Health Informatics Series
Edition description:	2nd ed. 2007
Pages:	270
Product dimensions:	6.14(w) x 9.25(h) x 0.03(d)

About the Author

Eta S. Berner, EdD, is a Professor of Health Informatics at the University of Alabama at Birmingham.

Table of Contents

Development and Evaluation of Clinical Decision Support Systems.- Overview of Clinical Decision Support Systems.- Mathematical Foundations of Decision Support Systems.- Data Mining and Clinical Decision Support Systems.- Design and Implementation Issues.- Diagnostic Decision Support Systems.- Ethical and Legal Issues in Decision Support.- Clinical Trials of Information Interventions.- Applications of Clinical Decision Support Systems in Clinical Practice.- Clinical Decision Support at Intermountain Healthcare.- Clinical Decision Support Within the Regenstrief Medical Record System.- Decision Support During Inpatient Care Provider Order Entry: The Vanderbilt Experience.- Decision Support for Patients.

Editorial Reviews

Reviewer: Keri L Christensen, BSE (Northwestern University Feinberg School of Medicine)
Description: The first section of this book provides a technical overview of how clinical decision support systems (CDSS) can be structured and how they might work and then the second section details real-life examples from leaders in the industry about how clinical decision support systems can be implemented. A lot has changed in the field since 1999 when the first edition was published, so this is a necessary update.
Purpose: The author has three objectives: to provide a technical resource about CDSS for information specialists; a textbook for students in medical informatics programs, and a resource for clinicians interested in CDSS. These are worthy objectives, but rather disparate. The sections geared towards information specialists would be above the heads of most clinicians and are more in depth than some medical informatics students would need. The book as a whole, however, has at least some chapters that would be interesting and informative for each group.
Audience: The first half of the book is definitely focused on students and information technology specialists interested in learning the back-end workings of a clinical decision support system. The second half of the book would be more appealing to clinicians or healthcare leaders interested in implementing a clinical decision support system. The second half would also be valuable to students or IT specialists who want to understand how the programs are implemented and used, which would be very helpful so that they understand the types of functionality a CDSS needs to have and what is most useful and user-friendly. The authors were credible authorities and he institutions profiled in the second half of the book are leaders in the field.
Features: Section 1 provides a competent overview of clinical decision support systems: what they are, how they are designed, different ways they are used, and the purposes for which they are built. Legal issues are also addressed. My favorite chapter in this section, from a CDSS implementer's perspective, is chapter 7 on clinical trials of CDSSs. The bibliographies for the chapters in the first section are quite comprehensive and can direct readers to more information on any subject briefly touched upon in the overview. Section 2 is very well done, with excellent discussions on types of clinical decision support systems implemented by organizations, uses, timing, pitfalls, and lessons learned. Again, the citations are very helpful and serve almost as a recommended reading list for the topic.
Assessment: This book is especially well suited for students in health informatics who are interested in designing and developing clinical decision support systems. It provides an excellent overview with suitable references for continued learning. The book is less well suited for those looking to implement a clinical decision support system, as it attempts to teach more than these persons may be interested in knowing. I especially like the inclusion of the case examples at the end, particularly for the audience of CDSS developers: all too often system developers have only a fuzzy idea of how the system would be used in practice. The authors have provided some great examples and guidance in this regard.

Doody's Review Service

Reviewer: Keri L Christensen, BSE(Northwestern University Feinberg School of Medicine)
Description: The first section of this book provides a technical overview of how clinical decision support systems (CDSS) can be structured and how they might work and then the second section details real-life examples from leaders in the industry about how clinical decision support systems can be implemented. A lot has changed in the field since 1999 when the first edition was published, so this is a necessary update.
Purpose: The author has three objectives: to provide a technical resource about CDSS for information specialists; a textbook for students in medical informatics programs, and a resource for clinicians interested in CDSS. These are worthy objectives, but rather disparate. The sections geared towards information specialists would be above the heads of most clinicians and are more in depth than some medical informatics students would need. The book as a whole, however, has at least some chapters that would be interesting and informative for each group.
Audience: The first half of the book is definitely focused on students and information technology specialists interested in learning the back-end workings of a clinical decision support system. The second half of the book would be more appealing to clinicians or healthcare leaders interested in implementing a clinical decision support system. The second half would also be valuable to students or IT specialists who want to understand how the programs are implemented and used, which would be very helpful so that they understand the types of functionality a CDSS needs to have and what is most useful and user-friendly. The authors were credible authorities and he institutions profiled in the second half of the book are leaders in the field.
Features: Section 1 provides a competent overview of clinical decision support systems: what they are, how they are designed, different ways they are used, and the purposes for which they are built. Legal issues are also addressed. My favorite chapter in this section, from a CDSS implementer's perspective, is chapter 7 on clinical trials of CDSSs. The bibliographies for the chapters in the first section are quite comprehensive and can direct readers to more information on any subject briefly touched upon in the overview. Section 2 is very well done, with excellent discussions on types of clinical decision support systems implemented by organizations, uses, timing, pitfalls, and lessons learned. Again, the citations are very helpful and serve almost as a recommended reading list for the topic.
Assessment: This book is especially well suited for students in health informatics who are interested in designing and developing clinical decision support systems. It provides an excellent overview with suitable references for continued learning. The book is less well suited for those looking to implement a clinical decision support system, as it attempts to teach more than these persons may be interested in knowing. I especially like the inclusion of the case examples at the end, particularly for the audience of CDSS developers: all too often system developers have only a fuzzy idea of how the system would be used in practice. The authors have provided some great examples and guidance in this regard.

This book reviews the history, development, theory, and implementation of clinical diagnostic decision support systems (CDDSS). It is divided into sections dealing with the scientific/mathematical features of CDDSS, how and for what purposes these systems are used, and where future development is headed. The editor proposes to provide a resource for CDDSS informatics specialists, a textbook for studies in CDDSS, and an introduction for clinicians interested in this field. These are worthy goals, especially those designed to enlighten novices. The book does well as a resource for informatics specialists and an introduction for newcomers, but lacks a structure robust enough to work as a textbook, since several of the chapters read more like articles. It is written for clinicians with an interest in CDDSS, medical and healthcare information students learning about CDDSS, and informatics researchers who do not regularly perform CDDSS. The content seems to be too basic for experts in CDDSS. Aside from the healthcare fields, I think computer scientists with an interest in decision support will find the book interesting because it details the state of the art in medical decision making. The contributors are very credible The contributors state in may different ways the shortcomings of diagnostic decision support and barriers to its wide acceptance. From the "overview" chapter to the "future development" section, and all through the text, we are reminded that CDDSS has generally received lukewarm reception in the medical community at large. An appropriate amount of time is spent in dispelling myths about CDDSS (namely that CDDSS-neophytes tend to expect these systems to perform as "Greekoracles," providing precise and accurate diagnoses based on signs and symptoms). The editor and contributors convey that CDDSS should be used to support the diagnosis process, not replace clinical providers. The contributors did well in eliminating bias from their work. They could have espoused CDDSS in a utopian light. Rightfully, they reported the many "scientific" studies that seem to indicate CDDSS is of little value now and is not widely used. This kind of sober approach, coming from the very experts who want CDDSS to succeed and be valued, is refreshing and will serve to advance the field through constructive criticism.

Bruce Fish