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:

http://www.healthcareitnews.com/news/middleton-still-untangling-cds-promise

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.