AN INDUSTRIAL-PROCESS VIEW OF INFORMATION DELIVERY TO SUPPORT CLINICAL DECISION-MAKING - IMPLICATIONS FOR SYSTEMS-DESIGN AND PROCESS MEASURES

Clinical decision making is driven by information in the form of patie nt data and clinical knowledge. Currently prevalent systems used to st are and retrieve this information have high failure rates, which can b e traced to well-established system constraints. The authors use an in dustrial process model of clinical decision making to expose the role of these constraints in increasing variability in the delivery of rele vant clinical knowledge and patient data to decision-making clinicians . When combined with nonmodifiable human cognitive and memory constrai nts, this variability in information delivery is largely responsible f or the high variability of decision outcomes. The model also highlight s the supply characteristics of information, a view that supports the application of industrial inventory management concepts to clinical de cision support. Finally, the clinical decision support literature is e xamined from a process-improvement perspective with a focus on decisio n process components related to information retrieval. Considerable kn owledge gaps exist related to clinical decision support process measur ement and improvement.