Interaction model
Informaticians have been developing knowledge-based clinical decision support systems for over 30 years with many notable successes [Reisman, 1996]. Once the arduous tasks of collecting the medical knowledge required and developing an accurate computer understandable representation scheme are complete, the informatician must determine the appropriate user interaction model. The key item that must be considered is the nature of the medical decision being made. Many medical decisions are based on numerous simple and widely agreed upon, rules that all clinicians know but have difficulty bringing to bear with 100% accuracy. Examples of such decisions might include: Does this infant need an MMR vaccination today? Do these particular arterial blood gas values represent a metabolic or respiratory acidosis? Has the patient's sodium value fallen more than 25% over the last 12 hours? These determinations are best implemented as interpretation or monitoring systems. Other decisions are fraught with complicated risk assessments and competing alternatives; they have no clear-cut "best" solutions. Such decisions are best implemented as critiquing systems. The consultation mode, on the other hand, has not met with much success in the clinical realm for the simple reason that clinicians are reluctant to spend extended periods of time entering data into a computer in order to receive advice. Finding the appropriate user interaction model is one of the most important, but often overlooked, tasks.
- Reisman Y. Computer-based clinical decision aids. A review of methods and assessment of systems. Med Inf (Lond) 1996 Jul-Sep;21(3):179-97
