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Aspects of the use of medical decision-support systems: the role of context in decision support
Linköpings universitet, Institutionen för medicinsk teknik, Medicinsk informatik. Linköpings universitet, Institutionen för molekylär och klinisk medicin, Klinisk mikrobiologi. Linköpings universitet, Tekniska högskolan.
2001 (engelsk)Doktoravhandling, med artikler (Annet vitenskapelig)
Abstract [en]

There is a great need today for distribution of medical information. The amount of information is growing quickly, and information that could potentially influence clinical practice fails to reach health care professionals. The supply of information to health care has from the start been the main goal of medical informatics. However, with very few exceptions, the systems developed to support the formalization and distribution of medical knowledge, i.e. decision-support or expert systems, have not attained clinical use. Thus, since there is an unsatisfied need for information and the methods developed so far have been successful to only a limited extent, it is important to gain insight into both how decision-support systems are used and which of their properties may influence the usability.

This thesis describes aspects of the use of medical decision-support systems by looking at two prototype implementations of such systems. The prototypes concerned bacterial endocarditis and urinary tract infections respectively. The first prototype system was evaluated and a theory of the use of the system was developed, thereby leading to further theorization and the development of a new system design. The goal of the system designs was to facilitate the interpretation and assessment of generated advice. This kind of support was realized by applying an expertext system model, a model that supports triangulation of decision-support methods and information sources. To organize the information in an expertext environment, a common terminological domain model was used in the second system design. In the theorization, a special focus was on contextual aspects of system use. Differences between knowledge provider and end-user contexts concerning the use of decision-support systems were analyzed. The importance of support for multi-perspective interpretation of system output such as is present in our system designs was confirmed.

sted, utgiver, år, opplag, sider
Linköping: UNIT , 2001. , s. 45
Serie
Linköping Studies in Science and Technology. Dissertations, ISSN 0345-7524 ; 662
HSV kategori
Identifikatorer
URN: urn:nbn:se:liu:diva-29007Lokal ID: 14240ISBN: 91-7219-896-6 (tryckt)OAI: oai:DiVA.org:liu-29007DiVA, id: diva2:249819
Disputas
2001-01-09, Sal 1, Farmakologen, Plan 8, Universitetssjukhuset, Linköping, 09:00 (svensk)
Tilgjengelig fra: 2009-10-09 Laget: 2009-10-09 Sist oppdatert: 2013-02-19
Delarbeid
1. Extended telemedical consultation using Arden Syntax based decision support, hypertext and WWW technique
Åpne denne publikasjonen i ny fane eller vindu >>Extended telemedical consultation using Arden Syntax based decision support, hypertext and WWW technique
Vise andre…
1997 (engelsk)Inngår i: Methods of Information in Medicine, ISSN 0026-1270, Vol. 36, nr 2, s. 108-114Artikkel i tidsskrift (Fagfellevurdert) Published
Abstract [en]

There is an obvious need for geographic distribution of expert knowledge among several health care units without increasing the cost of on-site expertise in locations where health care is provided. This paper describes the design of a knowledge-based decision-support system for extended consultation in clinical medicine. The system is based on Arden Syntax for Medical Logic Modules and hypertext using World Wide Web technology. It provides advice and explanations regarding the given advice. The explanations are presented in a hypertext format allowing the user to browse related information and to verify the relevance of the given advice. The system is intended to be used in a closed local network. With special precautions regarding issues of safety and patient security, the system can be used over wider areas such as in rural medicine. A prototype has been developed in the field of clinical microbiology and infectious diseases regarding infective endocarditis.

HSV kategori
Identifikatorer
urn:nbn:se:liu:diva-13333 (URN)9242006 (PubMedID)
Tilgjengelig fra: 2008-06-18 Laget: 2008-06-18 Sist oppdatert: 2017-12-13
2. A study of the usage of a decision-support system for infective endocarditis
Åpne denne publikasjonen i ny fane eller vindu >>A study of the usage of a decision-support system for infective endocarditis
2000 (engelsk)Inngår i: Medical informatics and the Internet in medicine (Print), ISSN 1463-9238, E-ISSN 1464-5238, Vol. 25, nr 1, s. 1-18Artikkel i tidsskrift (Fagfellevurdert) Published
Abstract [en]

The objective of this study was to examine a design for a World Wide Web-based decision-support system in use by clinically active physicians. A prototype implementation of the design concerned management of infective endocarditis patient cases. The design was based on an integration of hypertext and rule-based knowledge. In the study sessions, physicians in the field of internal medicine worked on managing authentic patient cases in a laboratory setting. Data was collected from interviews with the physicians using video recordings and stimulated recall technique. The qualitative data was analysed according to the constant comparative method in order to develop a model of the physicians' usage of the system. The resulting model describes perceived contributions and criteria for usefulness of the system. The ways the physicians used the system showed that it was able to provide patient-specific support for confirming clinical decisions, for higher-level patient management, and for preparing for and initiating expert consultations. Users also stated that new medical knowledge could be gained as a side effect of using the system.

Emneord
Decision-support System, Endocarditis, Qualitative Methodology, Evaluation
HSV kategori
Identifikatorer
urn:nbn:se:liu:diva-13334 (URN)10.1080/146392300298229 (DOI)
Tilgjengelig fra: 2008-06-18 Laget: 2008-06-18 Sist oppdatert: 2017-12-13
3. A study of the concept of urinary tract infections in different domains of medicine using the MEDLINE® database
Åpne denne publikasjonen i ny fane eller vindu >>A study of the concept of urinary tract infections in different domains of medicine using the MEDLINE® database
(engelsk)Manuskript (preprint) (Annet vitenskapelig)
Abstract [en]

In the construction of decision-support systems, differences between expert and end-user domains may pose a problem. As a way of studying differences between medical domains regarding management of urinary tract infections, we investigated the MEDLINE® for differences in indexing patterns. Further, our intention was to assess the MEDLINE® database as a source for studying medical domains. We examined the use of main headings, subheadings and the level of main headings in six medical domains that manage urinary tract infections. Many intuitive but also some counterintuitive results were found. We conclude that it is difficult to use the MEDLINE® database for studying medical domains mainJy due to unclear semantics both in the headings and the indexing process, which results in variability in indexing. This variability probably hides significant results. We also conclude that the differences found indicate that in addition to differences between domains, there are also large variations within domains.

HSV kategori
Identifikatorer
urn:nbn:se:liu:diva-88955 (URN)
Tilgjengelig fra: 2013-02-19 Laget: 2013-02-19 Sist oppdatert: 2013-02-19
4. Medical decision-support systems and the concept of context
Åpne denne publikasjonen i ny fane eller vindu >>Medical decision-support systems and the concept of context
2004 (engelsk)Inngår i: Medical informatics and the Internet in medicine (Print), ISSN 1463-9238, E-ISSN 1464-5238, Vol. 29, nr 2, s. 109-118Artikkel i tidsskrift (Fagfellevurdert) Published
Abstract [en]

Medical decision-support systems are of necessity multi-contextual in nature. There are always at least two contexts involved in the use of such systems: the expert knowledge-provider context and the end-user context. To show this, we present examples of context-dependent aspects significant to the use of decision-support systems. The existence of discrepancies between the contexts threatens to disrupt the rationale for using decision-support systems: for the system to transfer knowledge from the expert to the end-user. Both theoretical and empirical studies show that such discrepancies exist and that they may be detrimental to the use of decision-support systems. Systems must thus give support in interpreting the output produced by the system in the context of the end-user. © 2004 Taylor and Francis Ltd.

HSV kategori
Identifikatorer
urn:nbn:se:liu:diva-28810 (URN)10.1080/14639230410001684404 (DOI)13998 (Lokal ID)13998 (Arkivnummer)13998 (OAI)
Tilgjengelig fra: 2009-10-09 Laget: 2009-10-09 Sist oppdatert: 2017-12-13
5. A design and prototype for a decision-support system in the field of urinary tract infections: application of openGALEN techniques for indexing medical information
Åpne denne publikasjonen i ny fane eller vindu >>A design and prototype for a decision-support system in the field of urinary tract infections: application of openGALEN techniques for indexing medical information
2001 (engelsk)Inngår i: Studies in Health Technology and Informatics, ISSN 0926-9630, E-ISSN 1879-8365, Vol. 84, nr 1, s. 479-483Artikkel i tidsskrift (Fagfellevurdert) Published
Abstract [en]

Differences in expert and end-user contexts may be detrimental to the use of decision-support systems. A way to attend to this problem is to triangulate decision-support methods and information sources such as in the case of the expertext system model. To organize the information contained in the system, a common domain model is suggested as a instrument for annotating information. In this paper, a design and a prototype for a decision-support system in the field of urinary tract infections using techniques and methods developed in the GALEN projects is presented.

sted, utgiver, år, opplag, sider
Amsterdam: IOS Press, 2001
HSV kategori
Identifikatorer
urn:nbn:se:liu:diva-29003 (URN)10.3233/978-1-60750-928-8-479 (DOI)14236 (Lokal ID)14236 (Arkivnummer)14236 (OAI)
Konferanse
MEDINFO 2001, 10th World Congress on Medical Informatics, London, United Kingdom
Tilgjengelig fra: 2009-10-09 Laget: 2009-10-09 Sist oppdatert: 2017-12-13

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