title: Towards integration of clinical decision support in commercial hospital information systems using distributed, reusable software and knowledge components.
abstract: OBJECTIVE
  Clinicians' acceptance of clinical decision support depends on its workflow-oriented, context-sensitive accessibility and availability at the point of care, integrated into the Electronic Patient Record (EPR). Commercially available Hospital Information Systems (HIS) often focus on administrative tasks and mostly do not provide additional knowledge based functionality. Their traditionally monolithic and closed software architecture encumbers integration of and interaction with external software modules. Our aim was to develop methods and interfaces to integrate knowledge sources into two different commercial hospital information systems to provide the best decision support possible within the context of available patient data.
  
  
  METHODS
  An existing, proven standalone scoring system for acute abdominal pain was supplemented by a communication interface. In both HIS we defined data entry forms and developed individual and reusable mechanisms for data exchange with external software modules. We designed an additional knowledge support frontend which controls data exchange between HIS and the knowledge modules. Finally, we added guidelines and algorithms to the knowledge library.
  
  
  RESULTS
  Despite some major drawbacks which resulted mainly from the HIS' closed software architectures we showed exemplary, how external knowledge support can be integrated almost seamlessly into different commercial HIS. This paper describes the prototypical design and current implementation and discusses our experiences.
authors.affiliation: Department of Medical Informatics and Biomathematics, University of Münster, Domagkstr. 9, 48129 Münster, Germany. marcel.mueller@uni-muenster.de
authors.forename: M L
authors.initials: ML
authors.lastname: Müller
authors.forename: T
authors.initials: T
authors.lastname: Ganslandt
authors.forename: H P
authors.initials: HP
authors.lastname: Eich
authors.forename: K
authors.initials: K
authors.lastname: Lang
authors.forename: C
authors.initials: C
authors.lastname: Ohmann
authors.forename: H U
authors.initials: HU
authors.lastname: Prokosch
mesh_terms: D015746:Abdominal Pain / Q000209:etiology; D000465:Algorithms; D001185:Artificial Intelligence; D020000:Decision Support Systems, Clinical; D006751:Hospital Information Systems; D006801:Humans; D016347:Medical Records Systems, Computerized; D012984:Software