Decision Support Discussions

From EGADSSWiki

Static vs. Temporal Decision Support

At this time, EGADSS supports only a static view of DSS for the provider.

Arden Syntax, the guideline formalism for the first version of EGADSS, is an “atomic” guideline formalism. It does not support longitudinal guidelines, rather the MLMs (Medical Logic Modules) contain enough information to make a single clinical decision. While more complex models exist, Arden Syntax, does fit the need for the EGADSS project and the development of point of care preventive reminders.

EGADSS itself does not have any detailed internal representation of time and only responds to the patient summary that is sent from the clinical information system. It doesn't maintain a list of patient summaries and therefore only responds to the current snapshot in the summary.

It should be pointed out that decision support recommendations from EGADSS do change over time, even though we are taking a "static" approach to reminders. At each encounter, the recommendations from EGADSS may change, based on the patient data set and the guideline knowledge base. Rather, the decision support process occurs serially, but it does so each time with a static view of the patient through the facts presented through the Patient Model.

Guideline Contraindications

Guideline contraindications can be quite vague. For example, in the Measles, Mumps, Rubella (MMR) guideline in the immunizations module contraindications include "severe acute illness, pregnancy, immunosuppression (significant HIV, organ transplant, prednisone), reaction to gelatin or neomycin."

For the immediate future we're using a limited set of contraindications as a proof of concept. The framework will then be extended to a more comprehensive set of conditions. We will consider HIV, pregnancy, pneumonia, cellulitis, and endocarditis encoded using ICD-9.