title: Clinical Decision Support Systems (CDSS) for preventive management of COPD patients.
abstract: BACKGROUND
  The use of information and communication technologies to manage chronic diseases allows the application of integrated care pathways, and the optimization and standardization of care processes. Decision support tools can assist in the adherence to best-practice medicine in critical decision points during the execution of a care pathway.
  
  
  OBJECTIVE
  The objectives are to design, develop, and assess a clinical decision support system (CDSS) offering a suite of services for the early detection and assessment of chronic obstructive pulmonary disease (COPD), which can be easily integrated into a healthcare providers' work-flow.
  
  
  METHODS
  The software architecture model for the CDSS, interoperable clinical-knowledge representation, and inference engine were designed and implemented to form a base CDSS framework. The CDSS functionalities were iteratively developed through requirement-adjustment/development/validation cycles using enterprise-grade software-engineering methodologies and technologies. Within each cycle, clinical-knowledge acquisition was performed by a health-informatics engineer and a clinical-expert team.
  
  
  RESULTS
  A suite of decision-support web services for (i) COPD early detection and diagnosis, (ii) spirometry quality-control support, (iii) patient stratification, was deployed in a secured environment on-line. The CDSS diagnostic performance was assessed using a validation set of 323 cases with 90% specificity, and 96% sensitivity. Web services were integrated in existing health information system platforms.
  
  
  CONCLUSIONS
  Specialized decision support can be offered as a complementary service to existing policies of integrated care for chronic-disease management. The CDSS was able to issue recommendations that have a high degree of accuracy to support COPD case-finding. Integration into healthcare providers' work-flow can be achieved seamlessly through the use of a modular design and service-oriented architecture that connect to existing health information systems.
authors.forename: Filip
authors.initials: F
authors.lastname: Velickovski
authors.forename: Luigi
authors.initials: L
authors.lastname: Ceccaroni
authors.forename: Josep
authors.initials: J
authors.lastname: Roca
authors.forename: Felip
authors.initials: F
authors.lastname: Burgos
authors.forename: Juan B
authors.initials: JB
authors.lastname: Galdiz
authors.forename: Nuria
authors.initials: N
authors.lastname: Marina
authors.forename: Magí
authors.initials: M
authors.lastname: Lluch-Ariet
mesh_terms: D000465:Algorithms; D003142:Communication; D003657:Decision Making; D020000:Decision Support Systems, Clinical; D003936:Diagnosis, Computer-Assisted; D006801:Humans; D016730:Program Development; D029424:Pulmonary Disease, Chronic Obstructive / Q000503:physiopathology* / Q000517:prevention & control*; D015272:Pulmonary Medicine / Q000379:methods; D012984:Software; D013147:Spirometry; D057188:Workflow