Problem Knowledge Couplers: reengineering evidence-based medicine through interdisciplinary development, decision support, and research.
The rapid growth of medical knowledge is creating a demand for new ways of providing information in support of evidence-based medical practice. Problem Knowledge Couplers are a clinical decision support software tool that offer a new approach to this growing problem. Couplers are developed through a collaboration among clinicians, informaticians, and librarians. They recognize that functionality must be predicated upon combining unique patient information, gleaned through relevant structured question sets, with the appropriate knowledge found in the world's peer-reviewed medical literature. Two pilot studies indicate that couplers can meet the gold standards of decision making within both a primary care and a specialty practice. Issues remain about how to best integrate Problem Knowledge Couplers into clinical practice and whether large-scale outcomes research will support the findings of pilot studies. However, Problem Knowledge Couplers represent a promising approach that might portend a new model for health care delivery in the next millennium.
McGowan
J J
JJ
Vermont Initiative for Rural Health Informatics and Telemedicine, University of Vermont and Fletcher Allen Health Care, Burlington 05405, USA.
Winstead-Fry
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D000293:Adolescent; D000328:Adult; D000368:Aged; D003658:Decision Making, Computer-Assisted; D020000:Decision Support Systems, Clinical; D019317:Evidence-Based Medicine; D005194:Family Practice; D005260:Female; D006801:Humans; D008173:Lung Diseases, Obstructive / Q000175:diagnosis / Q000628:therapy; D008875:Middle Aged; D009722:Nurse Practitioners; D010865:Pilot Projects; D015272:Pulmonary Medicine