Tonight, some health IT, with contributions from our very own Matt Wills, GA.

El-Gayar, Deokar, Wills (2008), “Current Issues and Future Trends of Clinical Decision Support Systems (CDSS).” written for an encyclopedia…

Matt says the paper was written mainly to map the field and identify gaps.

Serious issues in safety and access that CDSS can address! Scarce resources, spiraling costs — these are all issues that drive better CDSS. Matt mentions the 1999 Institute of Medicine report that found 48K-98K die each year as a result of medical error. The financial cost of those errors: $6B per year.

ULAM: a liver allocation model! Ew!

Dang! Matt says there’s a lack of research that says CDSS resuls in clear clinical benefits. The research isn’t saying CDSS produces no results; the problem is develping clear metrics and baselines and generalizing results. The existing research is mostly anecdotal.

One hindrance to CDSS research: clinician throughput! They don’t want participation in an experiment with some new tech tht would cut down the number of patients they could process each day.

Another problem: physician autonomy. They don’t want a machine telling them what to do. So maybe there’s an opening for CDSS in medical school first, as a pedagogical tool. Test it out in the low-risk area, with interns who still have doctors supervising them, with students who are confronting simpler problems with clearer answers. Apply the CDSS to simulations, benchmark with established student norms and medical knowledge.

Physicians need transparency in the CDSS! They want to know how the diagnosis or recommendation was arrived at.

Matt says we need better Natural Language Processing (NLP) technology, especially to read all the “unstructured text” that physicians generate — just another example of how this is a very young field with a lot remaining to be done.

Matt would like to see more research on collaboration in the clinical setting. Lots of interesting telemedicine issues to be studied here — Matt finds a gap in the lit there!

Prof asks for a simple summary of major issues in DSS research, as discussed in Arnott and Pervan (2005, 2008) and Shim et al. (2002), and I have to go off advocating wholesale destruction of an industry….

The above articles appear to point to three pressing issues in DSS research: relevance, relevance, and relevance. Technology and business are changing fast. The increasing accumulation of data and easy access to it mean that those entrepreneurs who have the tools and talent to sift through that data and translate it into knowledge and action will have a competitive advantage over those who don’t… or even those who do but do so more cautiously. While the academic careers of researchers may hinge upon articles that take five years to make the grueling journey from inception to acceptance and publication, five-year-old data for practitioners is often laughably obsolete. (more…)

This could as easily go on CAH-HULK, but it’s more specific to the 838 project. Here’s the initial e-mail I sent to Dr. Deokar, seeking permission to pursue this topic for our semester paper assignment:

I’m considering possibilities for the semester research project for INFS 838. I’m focusing on the decision support side at the moment. I’m looking at building on the topic I worked on Dr. Sarnikar’s INFS 830 DSS class in Fall 2008: designing an online tool to support participatory budgeting, a public decision-making process. Attached is the draft I submitted for that course. I’d like to build on it with the following:

  • much heavier lit review and theory (since focus of project was definition of problem and design)
  • further review of material on participatory budgeting (most is overseas, very little in U.S., but I want to to keep looking for possible existing implementations);
  • development of a working online version;
  • expansion of the design and data to do multi-jurisdictional planning (city and county);
  • and maybe even some public trial runs (informal, of course, since I can’t get the city or county commissions to vote my research into legal force).

All systems go so far….

Arnott, D., & Pervan, G. (2005). A critical analysis of decision support systems research. Journal of Information Technology, 20, 67‐87.

More summarizing, another Arnott and Pervan work, this one from 2005. These guys spent a lot of time reading the DSS literature.

Arnott and Pervan (2005) appear to get one thing… well, one should not say wrong in these genteel academic confines, so let’s just say there’s an incomplete hypothesis. They point to the predominace of theory building and theory testing and the lack of theory refinement. (more…)

We’re reading Arnott and Pervan (2008) for INFS 838. The authors perform a content analysis of over a thousand decision support systems research articles published from 1990 to 2004 in an effort to identify trends and concerns in DSS research.

Among the problems they find is a relative lack of exposure in “A” journals. On the whole, DSS is relatively well represented, but (more…)