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Clinical Decision Support Systems (CDSS) for preventive management of COPD patients.

Velickovski F, Ceccaroni L, Roca J, Burgos F, Galdiz JB, Marina N, Lluch-Ariet M - J Transl Med (2014)

Bottom Line: Web services were integrated in existing health information system platforms.Specialized decision support can be offered as a complementary service to existing policies of integrated care for chronic-disease management.Integration into healthcare providers' work-flow can be achieved seamlessly through the use of a modular design and service-oriented architecture that connect to existing health information systems.

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ABSTRACT

Background: The use of information and communication technologies to manage chronic diseases allows the application of integrated care pathways, and the optimization and standardization of care processes. Decision support tools can assist in the adherence to best-practice medicine in critical decision points during the execution of a care pathway.

Objectives: The objectives are to design, develop, and assess a clinical decision support system (CDSS) offering a suite of services for the early detection and assessment of chronic obstructive pulmonary disease (COPD), which can be easily integrated into a healthcare providers' work-flow.

Methods: The software architecture model for the CDSS, interoperable clinical-knowledge representation, and inference engine were designed and implemented to form a base CDSS framework. The CDSS functionalities were iteratively developed through requirement-adjustment/development/validation cycles using enterprise-grade software-engineering methodologies and technologies. Within each cycle, clinical-knowledge acquisition was performed by a health-informatics engineer and a clinical-expert team.

Results: A suite of decision-support web services for (i) COPD early detection and diagnosis, (ii) spirometry quality-control support, (iii) patient stratification, was deployed in a secured environment on-line. The CDSS diagnostic performance was assessed using a validation set of 323 cases with 90% specificity, and 96% sensitivity. Web services were integrated in existing health information system platforms.

Conclusions: Specialized decision support can be offered as a complementary service to existing policies of integrated care for chronic-disease management. The CDSS was able to issue recommendations that have a high degree of accuracy to support COPD case-finding. Integration into healthcare providers' work-flow can be achieved seamlessly through the use of a modular design and service-oriented architecture that connect to existing health information systems.

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System interaction during confirmation of a COPD diagnosis in a primary care setting.
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Figure 4: System interaction during confirmation of a COPD diagnosis in a primary care setting.

Mentions: Figure 4 shows the use of the CDSS through a primary care scenario and the exchange of messages between Linkcare and the CDSS web services, with the objective for a clinician to confirm COPD in a patient. The clinician uses the Linkcare platform to enter the details of the patient in the system, or retrieve them from the EHR. The patient has already been assessed as being at risk of COPD, and the primary care clinician needs to confirm the COPD. For this, the primary care clinician needs to perform a full spirometry exam, i.e. two tests: one before the application of bronchodilators, and one after. To ensure the measurement taken with the spirometer satisfies criteria for an acceptable and reliable test, the full sampled signal, along with the lung function parameters are sent as two request messages, one for each test (pre and post-bronchodilation), to the Spirometry Quality Control web service. Linkcare uses the Diagnosis - Primary Care Evaluation web service to support the clinician in the decision of the diagnosis of the patient. The Linkcare platform sends the CDSS a request message with details of the lung function parameters obtained during the spirometry measurement. The CDSS replies with a response containing the evaluation to confirm the diagnosis and a recommendation to schedule an appointment for further evaluation and stratification.


Clinical Decision Support Systems (CDSS) for preventive management of COPD patients.

Velickovski F, Ceccaroni L, Roca J, Burgos F, Galdiz JB, Marina N, Lluch-Ariet M - J Transl Med (2014)

System interaction during confirmation of a COPD diagnosis in a primary care setting.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4255917&req=5

Figure 4: System interaction during confirmation of a COPD diagnosis in a primary care setting.
Mentions: Figure 4 shows the use of the CDSS through a primary care scenario and the exchange of messages between Linkcare and the CDSS web services, with the objective for a clinician to confirm COPD in a patient. The clinician uses the Linkcare platform to enter the details of the patient in the system, or retrieve them from the EHR. The patient has already been assessed as being at risk of COPD, and the primary care clinician needs to confirm the COPD. For this, the primary care clinician needs to perform a full spirometry exam, i.e. two tests: one before the application of bronchodilators, and one after. To ensure the measurement taken with the spirometer satisfies criteria for an acceptable and reliable test, the full sampled signal, along with the lung function parameters are sent as two request messages, one for each test (pre and post-bronchodilation), to the Spirometry Quality Control web service. Linkcare uses the Diagnosis - Primary Care Evaluation web service to support the clinician in the decision of the diagnosis of the patient. The Linkcare platform sends the CDSS a request message with details of the lung function parameters obtained during the spirometry measurement. The CDSS replies with a response containing the evaluation to confirm the diagnosis and a recommendation to schedule an appointment for further evaluation and stratification.

Bottom Line: Web services were integrated in existing health information system platforms.Specialized decision support can be offered as a complementary service to existing policies of integrated care for chronic-disease management.Integration into healthcare providers' work-flow can be achieved seamlessly through the use of a modular design and service-oriented architecture that connect to existing health information systems.

View Article: PubMed Central - HTML - PubMed

ABSTRACT

Background: The use of information and communication technologies to manage chronic diseases allows the application of integrated care pathways, and the optimization and standardization of care processes. Decision support tools can assist in the adherence to best-practice medicine in critical decision points during the execution of a care pathway.

Objectives: The objectives are to design, develop, and assess a clinical decision support system (CDSS) offering a suite of services for the early detection and assessment of chronic obstructive pulmonary disease (COPD), which can be easily integrated into a healthcare providers' work-flow.

Methods: The software architecture model for the CDSS, interoperable clinical-knowledge representation, and inference engine were designed and implemented to form a base CDSS framework. The CDSS functionalities were iteratively developed through requirement-adjustment/development/validation cycles using enterprise-grade software-engineering methodologies and technologies. Within each cycle, clinical-knowledge acquisition was performed by a health-informatics engineer and a clinical-expert team.

Results: A suite of decision-support web services for (i) COPD early detection and diagnosis, (ii) spirometry quality-control support, (iii) patient stratification, was deployed in a secured environment on-line. The CDSS diagnostic performance was assessed using a validation set of 323 cases with 90% specificity, and 96% sensitivity. Web services were integrated in existing health information system platforms.

Conclusions: Specialized decision support can be offered as a complementary service to existing policies of integrated care for chronic-disease management. The CDSS was able to issue recommendations that have a high degree of accuracy to support COPD case-finding. Integration into healthcare providers' work-flow can be achieved seamlessly through the use of a modular design and service-oriented architecture that connect to existing health information systems.

Show MeSH
Related in: MedlinePlus