On Validation and Verification Of Decision Support Protocol Subsystems During Implementation-Optimization: Encapsulating P(X)
How can we study integrated biomedical decision support (DS) protocols in clinical environments while remaining reasonably certain we will not confer harm in real world scenarios?
Outcomes on HIS from an arbitrary program P are used to validate that P does no harm on HIS during implementation-optimization. Predicates are used to help demonstrate how software specifications constrain the boundaries between the problem spaces of decision support subsystems and health information exchange (HIE). As values of the same data types visible in CPOE data exchange occur at these boundaries, they are used as a measure for software validation, as well as for measuring changes in Health Information Systems through special rules that transpose Health Information Exchange [HIE] metrics to impacts on HIS particular to each use case scenario.
The sum of these changes results in not only a measure of validity for P, but also for implementation-optimization of P in context of every use case scenario in any CPOE subsystem whose output domain is in the CPOE output space. Each use-case impact score is an algorithmic output specific to each HIE use case that considers: communication complexity; CPOE functional design parameters; HL7 direct health care delivery functions; CPOE and decision support operational constraint specifications, and the two entities in communication during the use case (e.g., "physician to hospital"; "clinician to health plan").
Each use case impacted by P's output () OUT(P(forall x in X)) is located by first tracing data flows nodes, and capturing time and space metrics in the exchanged data. When these data placed into a scoring algorithm (see TEST function, page 6) they represent a reliable dataset from which to measure how P(X) impacts health care by considering baseline measures taken in absence of P(X). Further, as this method utilizes use cases under CPOE, we are able to turn the system on itself, optimizing not P, but paths through the CPOE system itself, enabling higher clock cycles to paths deficient - in real time.