23 - Integration of knowledge resources into applications to enable clinical decision support: Architectural considerations

Abstract

The provision of proactive, actionable clinical decision support (CDS) represents one of the most promising strategies available for improving care quality and promoting patient safety. At the same time, however, the availability of robust CDS capabilities remains the exception rather than the norm in most health care settings in the United States and elsewhere. This chapter discusses how knowledge resources can be integrated into clinical applications to enable decision support. Multiple factors have contributed to the limited adoption of CDS technologies, including reimbursement models that fail to reward the delivery of higher quality care, limited research regarding return on investment, and the widely publicized problems associated with several large-scale health IT initiatives. Based on the way in which the health care marketplace has reacted to existing approaches to knowledge integration, it is clear that more widespread adoption of CDS capabilities will require a knowledge integration approach that is simple, flexible, content-rich, relatively inexpensive, and standardized.