临床决策支持
熟透番薯
Clinical Decision Support Systems are "active knowledge systems which
use two or more items of patient data to generate case-specific advice"
[Wyatt J, Spiegelhalter D, 1991].
Clinical DSSs are typically designed to integrate a medical knowledge
base, patient data and an inference engine to generate case specific
advice.
Functions
Four key functions of electronic clinical decision support systems are
outlined in [Perreault & Metzger, 1999]:
"Administrative: Supporting clinical coding and documentation,
authorization of procedures, and referrals.
"Managing clinical complexity and details: Keeping patients on research
and chemotherapy protocols; tracking orders, referrals follow-up, and
preventive care.
"Cost control: Monitoring medication orders; avoiding duplicate or
unnecessary tests.
"Decision support: Supporting clinical diagnosis and treatment plan
processes; and promoting use of best practices, condition-specific
guidelines, and population-based management. "
熟透番薯
Research into the use of artificial intelligence in medicine started in
the early 1970's and produced a number of experimental systems.
AAPHelp: de Dombal's system for acute abdominal pain (1972) An early
attempt to implement automated reasoning under uncertainty. De Dombal's
system, developed at Leeds University, was designed to support the
diagnosis of acute abdominal pain and, based on analysis, the need for
surgery. The system's decision making was based on the naive Bayesian
approach.
INTERNIST I (1974) Pople and Myers begin work on INTERNIST, one of the
first clinical decision support systems, designed to support diagnosis,
in 1970.
INTERNIST-I was a rule-based expert system designed at the University
of Pittsburgh in 1974 for the diagnosis of complex diagnosis of complex
problems in general internal medicine. It uses patient observations to
deduce a list of compatible disease states (based on a tree-structured
database that links diseases with symptoms). By the early 1980s, it was
recognized that the most valuable product of the system was its medical
knowledge base. This was used as a basis for successor systems
including CADUCEUS and Quick Medical Reference (QMR), a commercialised
diagnostic DSS for internists.