DECISION-SUPPORT IN MEDICINE - EXAMPLES FROM THE HELP SYSTEM

Computerized health information systems can contribute to the care rec eived by patients in a number of ways. Not the least of these is throu gh interactions with health care providers to modify diagnostic and th erapeutic decisions. Since its beginnings, developers have used the HE LP hospital information system to explore computerized interventions i nto the medical decision making process. By their nature these interve ntions imply a computer-directed interaction with the physicians, nurs es, and therapists involved in delivering care. In this paper we descr ibe four different approaches to this intervention. These include: (1) processes that respond to the appearance of certain types of clinical data by issuing an alert informing caregivers of these data's presenc e and import, (2) programs that critique new orders and propose change s in those orders when appropriate, (3) programs that suggest new orde rs and procedures in response to patient data suggesting their need, a nd (4) applications that function by summarizing patient care data and that attempt to retrospectively assess the average or typical quality of medical decisions and therapeutic interventions made by health car e providers. These approaches are illustrated with experience from the HELP system. (C) 1994 Academic Press, Inc.