System-Agnostic Clinical Decision Support Services: Benefits and Challenges for Scalable Decision Support

Kensaku Kawamoto
2010 Open Medical Informatics Journal  
System-agnostic clinical decision support (CDS) services provide patient evaluation capabilities that are independent of specific CDS systems and system implementation contexts. While such system-agnostic CDS services hold great potential for facilitating the widespread implementation of CDS systems, little has been described regarding the benefits and challenges of their use. In this manuscript, the authors address this need by describing potential benefits and challenges of using a
more » ... stic CDS service. This analysis is based on the authors' formal assessments of, and practical experiences with, various approaches to developing, implementing, and maintaining CDS capabilities. In particular, the analysis draws on the authors' experience developing and leveraging a system-agnostic CDS Web service known as SEBASTIAN. A primary potential benefit of using a system-agnostic CDS service is the relative ease and flexibility with which the service can be leveraged to implement CDS capabilities across applications and care settings. Other important potential benefits include facilitation of centralized knowledge management and knowledge sharing; the potential to support multiple underlying knowledge representations and knowledge resources through a common service interface; improved simplicity and componentization; easier testing and validation; and the enabling of distributed CDS system development. Conversely, important potential challenges include the increased effort required to develop knowledge resources capable of being used in many contexts and the critical need to standardize the service interface. Despite these challenges, our experiences to date indicate that the benefits of using a system-agnostic CDS service generally outweigh the challenges of using this approach to implementing and maintaining CDS systems. A system-agnostic CDS service can be loosely coupled with other functionally independent system components and services to fulfill various CDS needs [16, 17] Easier testing and validation SEBASTIAN test cases can focus solely on the underlying clinical decision logic [5] SEBASTIAN clinical decision rules can undergo batch regression testing [5] Enabling of distributed CDS development Medication CDS capabilities are developed across numerous vendors and institutions using commercial medication knowledge bases Duke enterprise care quality reporting system developed using SEBASTIAN, but with minimal need for involvement by SEBASTIAN development team
doi:10.2174/1874431101004010245 pmid:21603281 pmcid:PMC3097478 fatcat:hbummv7nxbgrdeajfthjcr52le