Decision support, knowledge representation and management in medicine.

OBJECTIVES: Clinical decision-support systems (CDSSs) are being recognized as important tools for improving quality of care. In this paper, we review the literature to find trends in CDSSs that were developed over the last few decades and give some indication of future directions in developing successful, usable clinical decision-support systems.
METHODS: We searched PubMed for papers that were published during the past five years with the words Decision Support Systems appearing in the title and used our own knowledge of the field for earlier work.
RESULTS: The goals of developers of modern CDSSs are to develop systems that deliver needed information and could be integrated with the healthcare's organizational dynamics. Such CDSSs form part of knowledge-management activities that healthcare organizations employ in order to excel. During the past few decades, we have witnessed a gradual maturation of knowledge representation formalisms and the needed infrastructure for developing integrated CDSSs, including electronic health record systems (EHR), standard terminologies, and messaging standards for exchange of clinical data. The demand for CDSSs that are effective and that will evolve as circumstances change gave rise to methodologies that guide developers on the construction and evaluation of CDSSs.
CONCLUSION: Although there exist many approaches for representing, managing and delivering clinical knowledge, the design and implementation of good and useful systems that will last and evolve are still active areas of research. The gradual maturation of EHR and infrastructure standards should make it possible for CDSSs implementers to make major contributions to the delivery of healthcare.