Exercise 2 : Procedure : from text books to Decision Support Systems

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Exercise 2 Procedure from text books to
Decision Support Systems

• Daniel Montero
• Toril Ormberg Reite
• Camille Vigier
• Elodie Vincent

TDT4210 Healthcare Informatics
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Presentation of the guidelines

• Decision supports
• Standardization of treatments or diagnoses
• Improve the education and the references
• Try to solve different problems medication,
  diagnoses, responsibility, cooperation
• The main components of a guideline
• Medical knowledge base
• Patient data the medical knowledge is used to
  interpret patient data
• Case specific advice

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Different types of guidelines

• They vary in
• The domains of care
• The type of decision Diagnostic or therapeutic
• The interaction with the user
• The knowledge representation (decision trees,
  Bayesian statistic)

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Studying of the example

• Area of focus heart disease
• The National Guideline Clearinghouse
• The pre-hospital management of acute heart
  attacks
• Prevention and therapeutic decisions for heart
  attacks
• A solicited advice

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The pre-hospital management of acute heart
attacks.
Pre-Hospital Resuscitation For Cardiac Arrest
Public education
Basic
Access to Care
Hospital Triage And Arrangements For Care For
Acute Coronary Syndromes
Ambulance Dispatch
Optimised
Early In-Hospital Management
Management of respiratory distress of presumed
cardiac origin, in addition to any relevant
measures shown above
Pre-Hospital Treatment Of Acute Coronary
Syndromes
Management of symptomatic arrhythmias.
Management of left ventricular failure presenting
as cardiogenic shock.
Management of cardiac arrest.
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Modelism Rules
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Management of non-complicated chest pain of
presumed cardiac origin
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Sick Patient
Relevant history
Assessment of vital signs
Establish ECG monitoring
Ensure resuscitation equipment is available or
coming.
systolic blood pressure gt90 ?
Bradycardia ?
Pain ?
Give short acting nitrate
Establish i.v. Access.
Is aspirin not contraindicated ?
Give aspirin 150 to 300 mg orally
Less Sick Patient
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Less Sick Patient
Wich Pain treatment?
Nitrate Treatment
Morphine
Still Pain ?
Give antiemetic such as metoclopramide
Does patient remain anxious despite opioid?
Give benzodiazepine
Are indications present for thrombolysis?
Initiate thrombolysis if appropriate in the
pre-hospital phase
Does the ECG show evidence of ischemia ?
A bolus of heparin should be given
New patient state
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Comparing with NEL (1/3)

• For this example NEL provides
• General description and statistics
• Causes and condotion development
• Diagnosis and list-model for treatment
• Medical recommendations (before and after
  hospital admittance)
• Recommendations on preventive action

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Comparing with NEL (2/3)

• NEL benefits
• Detailed
• Many recommendations
• NEL drawbacks
• Lack of overview
• Lack of decision support
• Difficult to model for general case

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Comparing with NEL (3/3)

• Similar
• Many of same basic and medical recommendations
• Differences
• Less case-specific (in this example)
• Easier to define course-of-action with
  Clearinghouse guideline
• Specific suggestions towards prevention

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Critical analysis

• Model does not support (and denote)
• Complications
• Medical alternatives
• Representation of actors involved
• Plecement of responsability