Friday, March 21, 2014

The Future For Clinical Decision Support From One Who Has Been There Almost Since The Start.

This appeared a little while ago.

Middleton still untangling CDS promise

Posted on Feb 03, 2014
By Anthony Brino, Editor, HIEWatch
Blackford Middleton, MD, first came across the term “clinical decision support” in 1983.
That’s when he was in medical school, at SUNY Buffalo, discussing health data management. “I thought that for the medical students and doctors it was ridiculous that we were carrying around clipboards to transfer data between hospital information systems,” said Middleton in a recent interview with Government nHealth IT. Today, Middleton is chief informatics officer at Vanderbilt University Health System and chair of the American Medical Informatics Association board.
Even back then, the year before Apple’s first personal computer went to market, he and his classmates thought it would be worthwhile for information systems to help clinicians with the complexity of diagnosis — and that endeavor continues.
As Vanderbilt and other institutions try to advance one of the most ambitious applications of clinical decision support, the field of pharmacogenomics, at both the molecular and computational levels, in the short-term Middleton is hoping the federal EHR incentive program can help raise the national baseline of evidence-based healthcare by making clinical decision support systems more accessible, intelligent and interoperable.
Middleton, who spent more than a decade at Partners HealthCare before landing at Vanderbilt, has had a front-row seat in the evolution of clinical decision support (CDS) systems — and a hand in developing them.
After med school, as an informatics fellow at Stanford in the early 1990s, he worked on the Quick Medical Reference DT system, through which clinicians entered symptoms and received advice on 700 disease profiles.
“We found it could make basic diagnoses pretty well, near to the level of a medical student perhaps, but not the expert clinician,” he said.
It had a number of limitations that continue in CDS to this day, including for what some consider the most advanced intelligence system, IBM’s Watson.
“Reasoning in computers is hard. They don’t know what they don’t know,” Middleton said. “Diagnosis is filled with nuance. That remains a fundamental challenge. It’s much more important to get the knowledge base right, because reasoning methods will evolve.”
Watson and other artificial intelligence systems are capable of learning from mistakes, though, and Middleton thinks the healthcare community should do the same when it comes to CDS systems and health IT in general.
 Lots more here:
For me what comes from this is that the path to perfection is CDS is not going to be a straight line. Increased computing power, innovations like IBM’s Watson and so on are all going to help as is the ongoing improvement in clinical knowledge and guidelines. Additionally we really have not worked out just what the best user interface for the CDS to interact with the clinician is and how it might work optimally.
There is a way to go but I really think we are on our way!
David.

6 comments:

Terry Hannan said...

David, another historical figure has written on this topic recently. L.Weed and L.Weed "Medicine In Denial".

Grahame Grieve said...

@Terry: I'm reading medicine in denial at the moment, and trying to figure out whether Mr&Mr Weed are smoking weed. I haven't finished, so perhaps this is premature, but it seems more wishful thinking than reality to me - they same tired canard that people can actually think about their health like anything else. Would you like to comment?

Bernard Robertson-Dunn said...

From the introduction to the "Medicine In Denial":

"It is in vain to expect any great progress in the sciences by the superinducing or engrafting new matters upon old. An instauration must be made from the very foundations, if we do not wish to revolve forever in a circle, making only some slight and contemptible progress.
Francis Bacon, 1620"

IMHO, the PCEHR, and most of the eHealth strategies I've seen, are grafting new matters on old. As I've said before, eHealth is not about IT, it's about better ways of delivering health care.

Anonymous said...

"they (sic) same tired canard that people can actually think about their health like anything else."

Grahame Grieve, you really need to elaborate on your statement/claim. What do you really mean??

Anonymous said...

"Has Been Their Almost Since The Start" ... I'm begging you, fix that grammatical error.

Dr David More MB PhD FACHI said...

Fixed - Sorry!

David.