The potential of training to increase acceptance and use of computerized decision support systems for medical diagnosis

OBJECTIVE: The goals of this study were to understand the reasons underlying the limited use of medical decision-support tools and to explore the potential of a computer-based tutorial to mitigate barriers to use. BACKGROUND: Medical decision-support tools such the Acute Cardiac Ischemia Time-Insensitive Predictive Instrument (ACI-TIPI) have demonstrated statistical validity and clinical impact for patient safety but have seen limited adoption and use. METHODS: The study developed a brief Web-based "demystifying" ACI-TIPI tutorial employing case-based training and evaluated the effectiveness of that tutorial in changing self-reported attitudes and behaviors. RESULTS: Clinicians using the tutorial reported greater understanding of how to use the ACI-TIPI score appropriately and increased confidence in the score. Case studies in the tutorial that provided examples of how to use the score for actual cases were rated as especially helpful. CONCLUSION: This study suggests that a primary barrier to the use of statistical decision support tools for patient diagnosis is lack of training or experience in combining a population-based numerical risk score with other diagnostic information about the individual patient's case that is not considered in that score. The results of this study indicate that there is a potential for a relatively brief tutorial to increase acceptance and use of decision support tools for medical diagnosis. APPLICATION: These findings have the potential for the identification of methods to help clinicians learn how to use statistical and probabilistic information to better assess risk and to promote integration of decision support tools into medical decision making for improvement of patient safety.     

Effective diagnosis of heart disease through neural networks ensembles

In the last decades, several tools and various methodologies have been proposed by the researchers for developing effective medical decision support systems. Moreover, new methodologies and new tools are continued to develop and represent day by day. Diagnosing of the heart disease is one of the important issue and many researchers investigated to develop intelligent medical decision support systems to improve the ability of the physicians. In this paper, we introduce a methodology which uses SAS base software 9.1.3 for diagnosing of the heart disease. A neural networks ensemble method is in the centre of the proposed system. This ensemble based methods creates new models by combining the posterior probabilities or the predicted values from multiple predecessor models. So, more effective models can be created. We performed experiments with the proposed tool. We obtained 89.01% classification accuracy from the experiments made on the data taken from Cleveland heart disease database. We also obtained 80.95% and 95.91% sensitivity and specificity values, respectively, in heart disease diagnosis.     

Diagnosis of valvular heart disease through neural networks ensembles

In the last decades, several tools and various methodologies have been proposed by the researchers for developing effective medical decision support systems. Moreover, new methodologies and new tools are continued to develop and represent day by day. Diagnosing of the valvular heart disease is one of the important issue and many researchers investigated to develop intelligent medical decision support systems to improve the ability of the physicians. In this paper, we introduce a methodology which uses SAS Base Software 9.1.3 for diagnosing of the valvular heart disease. A neural networks ensemble method is in the centre of the proposed system. The ensemble-based methods creates new models by combining the posterior probabilities or the predicted values from multiple predecessor models. So, more effective models can be created. We performed experiments with proposed tool. We obtained 97.4% classification accuracy from the experiments made on data set containing 215 samples. We also obtained 100% and 96% sensitivity and specificity values, respectively, in valvular heart disease diagnosis.     

Teachers’ opinion survey on the use of ICT tools to support attendance-based teaching

The present paper reports on the results obtained from a teachers’ opinion survey on the use of ICT tools to support of attendance-based teaching. In order to carry out this study, it was necessary to design a questionnaire to collect data among all in-service teachers with access to the university virtual campus. The findings show that respondents keep an open mind on incorporating ICT tools into their daily practices, on that point, this research has significantly contributed to the educational institution by providing accurate information about ICT use. The survey has also encouraged the university in its work on the integration of ICT in every area where it is possible, with the aim objectives of increasing access to learning, providing equal educational opportunities for all and ensuring lifelong learning, which are the mainstays of the Bologna Declaration.     

Information Systems that Really Support Decision-Making

Decision makers are expected to make decisions which have a positive effect on the future of their enterprises. We expect that intelligent information systems support their activities. Today, databases and web-based resources, accessed through effective communications, make information about the past rapidly available. To project the future the decision makers either have to use intuition or employ tool for prediction, and initialize such tools with information obtained from an information system to such tools. An effective information system should integrate forecasting the future, and because there choices have been made, such a system must also support the comparative assessment of the effects of alternate decisions. The complexity of an information system handling the past, and multiple futures will be great, and must be modularized with effective interfaces. We recommend the use of an SQL-like interface language to access existing tools to assess the future, as spreadsheets and simulations. Making results of simulations accessible as another contribution to integrated information systems has the potential of greatly augmenting their effectiveness and really support decision-making.     

Medical knowledge management for specific hospital departments

Medical knowledge representation and management is concerned with how to organise the often vague clinical experience of medical staff required for computable models. However, few knowledge management and acquisition tools have entered routine use, since such tools are not perceived by physicians as part of the clinical information process. An attempt to partially solve this problem, we identify two key aspects of knowledge representation and management tasks. The first is to adopt a medical knowledge standardisation to provide a consistent terminology control and to simplify the integration between knowledge management tools and the health information system. The second is to establish an effective knowledge acquisition process in specific medical fields by adapting knowledge acquisition tools. Therefore, the main goal of this work is to define computational models and to design mechanisms for the effective acquisition and management of medical knowledge in real-life hospital departments. To this end, we analyse the representation of medical knowledge (based on deep-causal models) and the development of knowledge management tools (based on ontologies), integrated within the information processing activities of the clinical user. Finally, we illustrate its applicability in the Intensive Care Unit and Pediatry scenarios.     

Towards knowledge-based systems in clinical practice: development of an integrated clinical information and knowledge management support system

Given that clinicians presented with identical clinical information will act in different ways, there is a need to introduce into routine clinical practice methods and tools to support the scientific homogeneity and accountability of healthcare decisions and actions. The benefits expected from such action include an overall reduction in cost, improved quality of care, patient and public opinion satisfaction. Computer-based medical data processing has yielded methods and tools for managing the task away from the hospital management level and closer to the desired disease and patient management level. To this end, advanced applications of information and disease process modelling technologies have already demonstrated an ability to significantly augment clinical decision making as a by-product. The wide-spread acceptance of evidence-based medicine as the basis of cost-conscious and concurrently quality-wise accountable clinical practice suffices as evidence supporting this claim. Electronic libraries are one-step towards an online status of this key health-care delivery quality control environment. Nonetheless, to date, the underlying information and knowledge management technologies have failed to be integrated into any form of pragmatic or marketable online and real-time clinical decision making tool. One of the main obstacles that needs to be overcome is the development of systems that treat both information and knowledge as clinical objects with same modelling requirements. This paper describes the development of such a system in the form of an intelligent clinical information management system: a system which at the most fundamental level of clinical decision support facilitates both the organised acquisition of clinical information and knowledge and provides a test-bed for the development and evaluation of knowledge-based decision support functions.     

A health information network for managing innercity tuberculosis: bridging clinical care, public health, and home care.

The purpose of this study was to use a health information network and innovative technology to coordinate tuberculosis care. An innercity medical center, a local health department, and a home care nurse service in northern Manhattan were used. The organizations were linked with computer networks. An automated decision support system with a natural language processor was used to detect tuberculosis cases and report them to the health department, and to select patients for respiratory isolation. Educational materials were placed on the World Wide Web and a Web-based kiosk. Home care nurses were outfitted with wireless pen-based computers, and data were relayed to the medical center. Automated tuberculosis case reporting resulted in time savings but not improved accuracy. Automated rules resulted in significant improvements in respiratory isolation. Kiosk educational materials were well-used. Wireless computing led to better access to information for both nurses and physicians, but not to reduction of workload. The key success element was recognition of critical priorities. It is concluded that innovative technology can facilitate the coordination of clinical care, public health, and home care.     

A Jini‐based software framework for developing distributed cooperative decision support systems

Many mission‐critical, decision‐making situations happen in dynamic, rapidly changing, and often unpredictable environments. Military, governmental, and medical contexts are examples of such situations, which can be characterized by highly decentralized, up‐to‐date data sets coming from various sources. Unlike other decision‐making tools, decision support systems (DSS) designed for such situations are challenged by the need to access this decentralized data at any time, from anywhere, under tight time constraints. This paper presents the design of a software framework for developing these kinds of distributed DSSs. The proposed Java‐based framework relies mostly on the Jini technology and its JavaSpaces service. The construction of the framework is presented with UML class diagrams, UML sequence diagrams, and additional explanations. Copyright © 2003 John Wiley & Sons, Ltd.     

Integrating spatial planning and flood risk management: A new conceptual framework for the spatially integrated policy infrastructure

Flooding is a widely occurring natural hazard that noticeably damages property, people, and the environment. In the context of climate change, the integration of spatial planning with flood-risk management has gained prominence as an approach to mitigating the risks of flooding. The absence of easy access to integrated and high-quality information, and the technologies and tools to use information are among the factors that impede this integration. Limited research has been conducted to develop a framework and to investigate the role of information and technologies in this integration. This study draws primarily on the European experiences and literature and identifies three dimensions of the integration of spatial planning with flood-risk management: territorial, policy, and institutional. To facilitate integration and in accord with these three dimensions, a Spatially Integrated Policy Infrastructure (SIPI) is conceptualised that encompasses data and information, decision support and analysis tools, and access tools and protocols. This study presents the connections between SIPI elements and integration dimensions, which is important for a better understanding of roles of geographic information and technologies in integration. The conceptual framework of SIPI will govern further development and evaluation of SIPI.     

A decision support system for product design in concurrent engineering

Compared with the traditional sequential design method, concurrent engineering is a systematic approach to integrate concurrent design of products and their related processes. One of the key factors to successfully implement concurrent engineering is information technology. In order to design a product and its manufacturing process simultaneously, information on product features, manufacturing requirements, and customer demands must be processed while the design is concurrently going on. There is an increased understanding of the importance of the correct decisions being made at the conceptual design and development stages that involve many complex evaluation and decision-making tasks. In order to promote the efficiency in concurrent product development, appropriate evaluation and decision tools need to be provided. In this paper, the characteristics of fuzzy, multi-stage evaluation and decision making in concurrent product development process are analyzed and a decision support system for product design in concurrent engineering is presented. An example is given to illustrate the application of the system.     

Healthcare support for underserved communities using a mobile social media platform

Emerging digital technologies for healthcare information support have already contributed to reducing the digital divide among rural communities. Although mobile health (m-health) applications facilitate provision of support for treatment consultation in real-time, their substantial potential has not yet been operationalised for decision support to meet citizen demand in developing nations. Modern healthcare information access, especially in rural areas of developing countries, is critical to effective healthcare, since both information and expert opinions are limited. Mobile phone and social media penetration, however, is often extensive. In this paper, we design and evaluate an innovative mobile decision support system (MDSS) solution for rural citizens healthcare decision support and information dissemination.Developed using a design science approach, the instantiated artifact connects underserved rural patients in Bangladesh to general practitioners (GPs) – allowing GPs, based on queries and information support provided, to evaluate patient conditions virtually and provide answers for further diagnosis or treatment. A cloud platform using social media embodies health record information and is used with a rating technique that matches queries to profiled remote experts, participating asynchronously. A comprehensive evaluation of the MDSS artifact ensures its utility, efficacy, and reliability.     

Analysis tools in the study of distributed decision-making: a meta-study of command and control research

Our understanding of distributed decision making in professional teams and their performance comes in part from studies in which researchers gather and process information about the communications and actions of teams. In many cases, the data sets available for analysis are large, unwieldy and require methods for exploratory and dynamic management of data. In this paper, we report the results of interviewing eight researchers on their work process when conducting such analyses and their use of support tools in this process. Our aim with the study was to gain an understanding of their workflow when studying distributed decision making in teams, and specifically how automated pattern extraction tools could be of use in their work. Based on an analysis of the interviews, we elicited three issues of concern related to the use of support tools in analysis: focusing on a subset of data to study, drawing conclusions from data and understanding tool limitations. Together, these three issues point to two observations regarding tool use that are of specific relevance to the design of intelligent support tools based on pattern extraction: open-endedness and transparency.     

中文电子病历命名实体和实体关系语料库构建

电子病历是由医务人员撰写的面向患者个体描述医疗活动的记录,蕴含了大量的医疗知识和患者的健康信息.电子病历命名实体识别和实体关系抽取等信息抽取研究对于临床决策支持、循证医学实践和个性化医疗服务等具有重要意义,而电子病历命名实体和实体关系标注语料库的构建是首当其冲的.在调研了国内外电子病历命名实体和实体关系标注语料库构建的基础上,结合中文电子病历的特点,提出适合中文电子病历的命名实体和实体关系的标注体系,在医生的指导和参与下,制定了命名实体和实体关系的详细标注规范,构建了标注体系完整、规模较大且一致性较高的标注语料库.语料库包含病历文本992份,命名实体标注一致性达到0.922,实体关系一致性达到0.895.为中文电子病历信息抽取后续研究打下了坚实的基础.     

Design and implementation of an environmental decision support system

An environmental decision support system is a specific version of an environmental information system that is designed to help decision makers, managers, and advisors locate relevant information and carry out optimal solutions to problems using special tools and knowledge. The RAISON (Regional Analysis by Intelligent Systems ON microcomputers) for Windows decision support system has been developed at the National Water Research Institute, Environment Canada, over the last 10 years. It integrates data, text, maps, satellite images, pictures, video and other knowledge input. A library of software functions and tools are available for selective extraction of spatial and temporal data that can be analysed using spatial algorithms, models, statistics, expert systems, neural networks, and other information technologies. The system is of a modular design which allows for flexibility in modification of the system to meet the demands of a wide range of applications. System design and practical experiences learned in the development of a decision support system for toxic chemicals in the Great Lakes of North America are discussed.     

The role of GPS-enabled information in transforming operational decision making: an exploratory study

Although the impact of ICT-enabled information on firm performance has been well documented in the business value of IT literature, our understanding of how Global Positioning System (GPS) adoption can transform operational decision making and foster differential firm performance is limited. In response, we conduct an exploratory comparative case study of three transport firms that have implemented the same GPS during the same year in their operations. Our results highlight that increased use of GPS-enabled information can enhance information quality and make operational decision making more fact-based and collaborative. We also find that such transformations in operational decision making, driven by increased use of GPS-enabled information, can foster differential performance impacts. However, we warn scholars and practitioners that a firm’s information management capability (in terms of availability of quality information in decision making, software tools for connectivity and access to information, IT systems integration post-GPS adoption and adaptability of the infrastructure to emerging business needs) and organizational factors (such as top management support, project management of GPS implementation, financial support, end-user involvement, rewarding, training and employee resistance) can facilitate (or inhibit) effective use of GPS-enabled information in operational decision making, and thus moderate differential performance benefits of GPS adoption.     

Streamlining patient consultations for sleep disorders with a knowledge-based CDSS

ObjectivesThis paper examines the workflow of sleep physicians during a patient consultation and how an innovative clinical decision support system (CDSS) provides efficiency and effectiveness gains.MethodsThe CDSS tools consisted of two input applications for patient data, with a knowledge based decision support system developed participatively with physicians and an international panel. An argument tree approach was used to produce diagnostic explanations and an evidence-based report for the physician using medically correct and shared terminology. A usability evaluation using a qualitative approach was carried out to ensure that the CDSS met the physicians׳ information needs, as well as the wider needs of a Sleep Investigation Unit.ResultsThe physicians found the CDSS both useful and usable with clear applications in triage and diagnostic decision-making, and in patient education.ConclusionThe CDSS both reduces the time and number of visits needed for consultations, and helps focus consultation on better individual patient care through informed explanation of diagnostic and treatment decisions.     

Ontology-based data integration and decision support for product e-Design

Currently, computer-based support tools are widely used to facilitate the design process and have the potential to reduce design time, decrease product cost and enhance product quality. Although there are promising information systems to manage product lifecycle and product-related data, including product data management (PDM) and product lifecycle management (PLM), significant limitations still exist, where information required to make decisions may not be available, may be lacking consistency, and may not be expressed in a general way for sharing between systems. Moreover, there remains little support for decision making that considers multiple complex technical and economical criteria, relations, and objectives in product design. To address these problems, this paper presents a framework for an ontology-based data integration and decision support environment for e-Design. The framework can guide designers in the design process, can make recommendations, and can provide decision support for parameter adjustments.     

Reading the medical record. I. Analysis of physicians' ways of reading the medical record.

Physicians were interviewed about their routines in everyday use of the medical record. From the interviews, we conclude that the medical record is a well functioning working instrument for the experienced physician. Using the medical record as a basis for decision making involves interpretation of format, layout and other textural features of the type-written data. Interpretation of these features provides effective guidance in the process of searching, reading and assessing the relevance of different items of information in the record. It seems that this is a skill which is an integrated part of diagnostic expertise. This skill plays an important role in decision making based on the large amount of information about a patient, which is exhibited to the reader in the medical record. This finding has implications for the design of user interfaces for reading computerized medical records.