Challenges in Electronic Decision Support Implementation

  • Prakash M. Nadkarni
Part of the Health Informatics book series (HI)


The previous chapter considered the various kinds of alerts. I now discuss how these can be implemented, and explore the issues related to standardization – more precisely, the lack of it. The presence of standards allows sharing of intellectual effort, so no one can be opposed to it in principle. However, while standardization has been enforced in many areas of biomedicine, standardization efforts in decision support have not been very successful to date. Let us first look at one of the root sources of the problem: namely, no one can mandate that all EMRs be built exactly alike.


Unify Modeling Language Database Schema Narrative Text Physical Schema Subroutine Library 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    Wang D. Knowledge representation with Arden. [cited 9/1/10]; Available from: 2004.
  2. 2.
    Jenders RA, Sujansky W, Broverman CA, Chadwick M. Towards improved knowledge sharing: assessment of the HL7 reference information model to support medical logic module queries. AMIA Fall Symposium, 1997.Google Scholar
  3. 3.
    Ludemann P. Mid-term report on the Arden Syntax in a clinical event monitor. Comput Biol Med. 1994;24(5):377-383.PubMedCrossRefGoogle Scholar
  4. 4.
    McConnell S. Code Complete. 2nd ed. Redmond: Microsoft Press; 2004.Google Scholar
  5. 5.
    Wright A, Sittig DF. A framework and model for evaluating clinical decision support architectures. J Biomed Inform. 2008;41(6):982-990.PubMedCrossRefGoogle Scholar
  6. 6.
    Pryor TA, Hripcsak G. The Arden syntax for medical logic modules. Int J Clin Monit Comput. 1993;10:215-224.PubMedCrossRefGoogle Scholar
  7. 7.
    Sailors RM, Bradshaw RL, East TD. Moving Arden Syntax outside of the (alert) box: a paradigm for supporting multi-step clinical protocols. AMIA Fall symposium 1998; 1998.Google Scholar
  8. 8.
    Pryor TA, Hripcsak G. Sharing MLM’s: an experiment between Columbia-Presbyterian and LDS hospital. Proc Annu Symp Comput Appl Med Care 1993: Washington DC; 1993:399–403.Google Scholar
  9. 9.
    Teitelbaum D, Guenter P, Howell WH, Kochevar ME, Roth J, Seidner DL. Definition of terms, style, and conventions used in A.S.P.E.N. Guidelines and standards. Nutr Clin Pract. 2005;20(2):281-285.PubMedCrossRefGoogle Scholar
  10. 10.
    Agency for Healthcare Research and Quality. National guideline clearinghouse [cited 11/2/10]; Available from: 2010.
  11. 11.
    The Society of Obstetricians and Gynaecologists of Canada. Ovulation induction in polycystic ovary syndrome. Int J Gynaecol Obstet. 2010;111(1):95-100.Google Scholar
  12. 12.
    Damiani G, Pinnarelli L, Colosimo SC, et al. The effectiveness of computerized clinical guidelines in the process of care: a systematic review. BMC Health Serv Res. 2010;10:2.PubMedCrossRefGoogle Scholar
  13. 13.
    Shiffman RN, Karras BT, Agrawal A, Chen R, Marenco L, Nath S. GEM: a proposal for a more comprehensive guideline document model using XML. J Am Med Inform Assoc. 2000;7(5):488-498.PubMedCrossRefGoogle Scholar
  14. 14.
    Moskovitch R, Shahar Y. Vaidurya: a multiple-ontology, concept-based, context-sensitive clinical-guideline search engine. J Biomed Inform. 2009;42(1):11-21.PubMedCrossRefGoogle Scholar
  15. 15.
    Turner R, Dufour J-C, Bouvenot J, Ambrosi P, Fieschi D, Fieschi M. Textual guidelines versus computable guidelines: a comparative study in the framework of the PRESGUID project in order to appreciate the impact of guideline format on physician compliance. AMIA Annu Symposium 2006; 2006:219–223.Google Scholar
  16. 16.
    First Databank. First Databank [cited 11/1/10]; Available from: 2010.
  17. 17.
    Health Language Inc. Health language [cited 11/1/10]; Available from: 2010.
  18. 18.
    Multum Corporation. The VantageRx database [cited 6/8/09]; Available from 2009.
  19. 19.
    Health Level 7 Virtual medical record [cited 11/3/10]; Available from 2010.
  20. 20.
    Peleg M, Keren S, Denekamp Y. Mapping computerized clinical guidelines to electronic medical records: knowledge-data ontological mapper (KDOM). J Biomed Inform. 2008;41(1):180-201.PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag London Limited 2011

Authors and Affiliations

  • Prakash M. Nadkarni
    • 1
  1. 1.School of MedicineYale UniversityNew HavenUSA

Personalised recommendations