Free and open source enabling technologies for patient-centric, guideline-based clinical decision support: a survey.
OBJECTIVE
Guideline-based clinical decision support is an emerging paradigm to help reduce error, lower cost, and improve quality in evidence-based medicine. The free and open source (FOS) approach is a promising alternative for delivering cost-effective information technology (IT) solutions in health care. In this paper, we survey the current FOS enabling technologies for patient-centric, guideline-based care, and discuss the current trends and future directions of their role in clinical decision support.


METHODS
We searched PubMed, major biomedical informatics websites, and the web in general for papers and links related to FOS health care IT systems. We also relied on our background and knowledge for specific subtopics. We focused on the functionalities of guideline modeling tools, and briefly examined the supporting technologies for terminology, data exchange and electronic health record (EHR) standards.


RESULTS
To effectively support patient-centric, guideline-based care, the computerized guidelines and protocols need to be integrated with existing clinical information systems or EHRs. Technologies that enable such integration should be accessible, interoperable, and scalable. A plethora of FOS tools and techniques for supporting different knowledge management and quality assurance tasks involved are available. Many challenges, however, remain in their implementation.


CONCLUSIONS
There are active and growing trends of deploying FOS enabling technologies for integrating clinical guidelines, protocols, and pathways into the main care processes. The continuing development and maturation of such technologies are likely to make increasingly significant contributions to patient-centric, guideline-based clinical decision support.
Leong
T Y
TY
Medical Computing Laboratory, School of Computing, National University of Singapore, Singapore. leongty@comp.nus.edu.sg
Kaiser
K
K
Miksch
S
S
D003625:Data Collection; D020000:Decision Support Systems, Clinical; D008490:Medical Informatics; D016347:Medical Records Systems, Computerized; D018802:Patient-Centered Care; D017410:Practice Guidelines as Topic
Artif Intell Med. 2004 May;31(1):1-27
15182844
Artif Intell Med. 2007 Feb;39(2):151-63
16962747
Stud Health Technol Inform. 2004;107(Pt 1):130-4
15360789
Methods Inf Med. 2004;43(4):413-26
15472756
Yearb Med Inform. 2006;:145-58
17051309
Bull Med Libr Assoc. 1993 Apr;81(2):170-7
8472002
Stud Health Technol Inform. 2004;101:132-6
15537215
J Biomed Inform. 2004 Jun;37(3):147-61
15196480
Health Aff (Millwood). 2005 Jan-Feb;24(1):151-62
15647226
Int J Med Inform. 2002 Dec 18;68(1-3):59-70
12467791
Proc AMIA Symp. 1999;:359-63
10566381
J Biomed Inform. 2006 Dec;39(6):656-67
16442854
Int J Med Inform. 2003 Jul;70(2-3):329-35
12909185
Stud Health Technol Inform. 2006;124:851-6
17108619
Artif Intell Med. 2001 May;22(2):111-31
11348843
Stud Health Technol Inform. 2001;84(Pt 1):280-4
11604749
Methods Inf Med. 1998 Nov;37(4-5):540-50
9865052
J Am Med Inform Assoc. 1998 May-Jun;5(3):276-92
9609498
Comput Methods Programs Biomed. 1994 Oct;45(1-2):75-8
7889770
Int J Med Inform. 2001 Dec;64(2-3):285-318
11734393
Artif Intell Med. 1998 Sep-Oct;14(1-2):29-51
9779882
J Am Med Inform Assoc. 2000 Sep-Oct;7(5):488-98
10984468
Health Aff (Millwood). 2005 Jan-Feb;24(1):18-28
15647212
AMIA Annu Symp Proc. 2003;:798
14728303
BMC Med Inform Decis Mak. 2007 Feb 12;7:3
17295907
J Am Med Inform Assoc. 2006 May-Jun;13(3):334-43
16501186
AMIA Annu Symp Proc. 2003;:758-62
14728275
J Am Med Inform Assoc. 2003 Sep-Oct;10(5):433-43
12807812
J Am Med Inform Assoc. 2006 May-Jun;13(3):353-5
16501183
Methods Inf Med. 2007;46(3):332-43
17492120
J Am Med Inform Assoc. 2003 Jan-Feb;10(1):52-68
12509357
Artif Intell Med. 1998 Sep-Oct;14(1-2):157-81
9779888
AMIA Annu Symp Proc. 2003;:51-5
14728132
J Am Med Inform Assoc. 2004 Sep-Oct;11(5):418-26
15187061
J Biomed Inform. 2004 Oct;37(5):325-44
15488747
Artif Intell Med. 2007 Feb;39(2):137-49
16963241
Stud Health Technol Inform. 2007;129(Pt 1):674-8
17911802
AMIA Annu Symp Proc. 2003;:982
14728486
Conf Proc IEEE Eng Med Biol Soc. 2006;2006:5141-4
17945878
Comput Biomed Res. 1994 Aug;27(4):291-324
7956129
AMIA Annu Symp Proc. 2005;:769-73
16779144
Stud Health Technol Inform. 2004;107(Pt 1):57-61
15360774