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Decision support linked to Laboratory Information systems

Decision support linked to Laboratory Information systems. Dr Gerard Boran Adelaide and Meath Hospital Dublin Incorporating the National Children’s Hospital. Overview of presentation. Definition of DSS What do they do? Target areas and users Methodologies Some examples of applications.

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Decision support linked to Laboratory Information systems

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  1. Decision supportlinked to Laboratory Information systems Dr Gerard Boran Adelaide and Meath Hospital Dublin Incorporating the National Children’s Hospital

  2. Overview of presentation • Definition of DSS • What do they do? • Target areas and users • Methodologies • Some examples of applications

  3. Decision Support SystemsSupport for Health Care Professionals • What is a decision support system? • "A DSS/KBS is any computer program designed to help health professionals make clinical decisions" [Shortliffe, 1987] e.g... • Information management • Focussing attention (alarms) • Consultation

  4. Decision Support SystemsSupport for Health Care Professionals • Desirable DSS Features: • can be configured by the local users • have measurable benefits for patients and staff • control “data intoxication” • promote cost-effectiveness and efficient use of resources • improve co-operation between central and remote labs • based on appropriate informatics and telematic standards • can be integrated with existing LIS, order communication systems, and relevant clinical information systems

  5. DSS versus KBS • Knowledge-based systems (KBS) are computer programs which seek to imitate human intelligence and expertise through the use of symbolic reasoning • DSS emphasise SUPPORT for the decision-making process

  6. Do labs need DSS? • Advances in laboratory technology • Automation • Integrated laboratories • distributed laboratories (satellite labs, point-of-care facilities, etc) • Increases in workload • Limitations on staff and resources

  7. What should they do? • Have measurable benefits for patients and staff • Measurable improvements in quality and efficiency • Be configurable by local users • Control data intoxication • promote efficient use of resources

  8. What do they do? • Information management • e.g activity, financial reports • Focusing attention • alarms on critical data • Consultation • Looking up manuals, protocols

  9. Target Users • Medical Staff • Nurses, e.g. ICU nurses • General Practitioners • e.g... • Test ordering protocols • Access to lab manuals • Alarms/alerts for critical data • Interpretative reports

  10. Target Users • Laboratory Scientists • QC procedures • instrument fault diagnosis • preventive maintenance • Managers • Monitor changes in costs, activity,etc

  11. Decision Support SystemsSupport for Health Care Professionals • Module Development • Structured Software Engineering Approach

  12. Decision Support SystemsSupport for Health Care Professionals • Techniques available • statistical/mathematical/graphical • algorithms • biodynamic models • knowledge-based systems (KBS) • Neural networks • Hypertext markup language

  13. Decision Support SystemsSupport for Health Care Professionals • Features of KBS technology • Reasoning ability • Explanation facilities • Learning by experience • Sensory perception (vision, hearing) • Language understanding (speech, writing) • Motor functions (robots, speech synthesis)

  14. Decision Support SystemsSupport for Health Care Professionals • KBS Structure • Knowledge Base • Rule List • List of comments/interpretations • Database • Inference Engine • Human-computer interface • Rule handling procedures

  15. Decision Support SystemsSupport for Health Care Professionals • Forward Chaining propagation Rule (1) IF ((Condition-1 is TRUE) (Condition-2 is TRUE) (...................)) THEN ((Condition-3 is TRUE) (Output Solution-1)) . . Rule (209) IF ((Condition-3 is TRUE) (Condition-4 is TRUE)) THEN ((Output Solution-1) (Terminate))

  16. Decision Support SystemsSupport for Health Care Professionals • Support for ordering investigations • Support for performing investigations • Support for interpretation

  17. Physician Result Test Requesting Interpretation Result Reporting Sample Collection Sample Analysis Preparation Decision Support SystemsTotal Testing Cycle

  18. Decision Support SystemsSupport for Health Care Professionals • Support for ordering investigations • Scheduling of Investigations • Dynamic Scheduling of Tests • Lab Information • Need to work with order communication systems

  19. Decision Support SystemsSupport for Health Care Professionals • Support for performing investigations • Advanced Instrument Interface • Remote Maintenance of Instruments • Instrument Fault Diagnosis/Troubleshooting • Quality Control • Validation of Results

  20. Decision Support SystemsSupport for Health Care Professionals • Support for interpretation • Alarms and Alerts • Graphical Presentation • Interpretative Reporting • Drug Alarms • Feedback for use with order communication systems

  21. Decision Support SystemsRelevant Decision Support Modules • Patient Result Validation • Thyroid Function • Lipid • Alarm/Alert • Acid-Base • Drug Interference • Haematology Image Interpretation • MI markers • Organ Profile interpretation • Cytology applications • Microbiology applications

  22. Integration • Integrate with routinely used IS • Data collection a by-product of routine activity • Absence of key data (often clinical data) hampers progress

  23. Integration • With LIS, e.g • HELP system • OpenLabs • Connolly • With HIS, e.g. • Order Communication systems • With other Clinical Systems, e.g. • Departmental systems (data feeds...) • Shared Care system

  24. OpenLabs architecture

  25. SHARED CARE Integrating Lab Data with other clinical systems Synapses Server Laboratory Hos. DB Renal Clinic Eye Clinic Consultant Synapses Server Hos. DB Lipid Clinic Lipid Clinic Eye Clinic Laboratory Diabetic Clinic Diabetic Clinic Renal Clinic Diabetic Day Centre Diabetic Day Centre General Practicioner Patient GP Tallaght DMS St. James Consultant

  26. The Test Cycle • PRE • INTRAPOST

  27. NPT/Satellite Lab 1 2 3 4 Clinician Investigate Interpret Main Lab Request Form/OCS Order 4. Reporting Collect Sample (Phlebotomy,etc) 3. QC/Validation 2. Analysis Transport to Lab PTS/Porters 1. Sample Prep

  28. Pre-laboratory applications • Ordering protocols • Order communications • LUMPS/BUMPS (Peters et al, 1991) • Dutch GP Guidelines

  29. Order communications

  30. Intra-laboratory Applications • QA Server • Patient Result Validation (Valdiguie, OpenLabs) • Lab Watch

  31. Post-laboratory Applications • Thyroid interpretation • protein electrophoresis interpretation • interpretive reporting (college guidelines) • Alarm systems • Data feeds to other DSS - e.g. diabetes register

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