Information contextualization in decision support modules for adverse drug event prevention.

This paper presents an analysis of hospitals' organization and Hospital Information Systems' features which can contribute in contextualization of Clinical Decision Support Systems (CDSS) for Adverse Drug Event (ADE) prevention. We identified four categories of contextualization: ENVIRONMENT, TASKS, USERS and TEMPORAL ASPECTS. Based on this analysis, we studied the technical possibilities at the architectural level to determine which component(s) of a standalone knowledge platform could technically handle contextualization. The results impact three types of components of this platform: (1) a CDSS providing decision support based on ADE signals mined in large data repositories; (2) a Connectivity Platform providing transformation and routing services (enabling any application to connect to the CDSS); (3) three prototype applications for accessing the decision support services realized within an industrial Computerized Physician Order Entry, an industrial Electronic Health Record and in an independent Web prototype, respectively. In each of the above components we present the dimension(s) of contextualization that has/have been determined to cope with and the design followed in the implementation phase.

Three different cases of exploiting decision support services for adverse drug event prevention.

Clinical Decision Support Systems (CDSSs) are implemented in clinical settings in order to improve patient outcomes and/or clinical practices. However, they are still not widely accepted by healthcare professionals due to over-alerting. The aim of the "Patient Safety through Intelligent Procedures in medication" (PSIP) project is to develop and demonstrate innovative tools so as to generate and provide relevant knowledge to healthcare professionals and patients for Adverse Drug Event (ADE) prevention by means of Information and Communication Technologies (ICT). PSIP employs a Knowledge Base (KB) as the core of its CDSS. This KB encapsulates signals capable of automatically detecting potential ADEs and contextualizing the CDSS output to the patient and healthcare professionals. To exploit the KB, a Global Knowledge Platform (GKP) has been created comprising of a KB system, a Connectivity Platform and appropriate user interface modules. The GKP has been tested to demonstrate integration of the KB in different work situations and it has been deployed in three different medical applications. The first is a Web application; the second involves a commercial French EHR (Electronic Health Record) and the third is a Danish CPOE (Computerised Physician Order Entry) system. This paper presents recent progress as regards the exploitation of the PSIP KB and the results obtained in the three different medical applications.