CLINICAL DECISION SUPPORT SYSTEM
Gerald Goertzel
International Business Machines Corporation
Advanced Systems Development Division
Yorktown Heights, N . Y .
For the past two and a half years, a group of us have been working on the
development of a computer system that will assist the physician in patient care.
The Clinical Decision Support System (CDSS) consists of computer programs
to aid in the acquisition of patient data and to suggest appropriate decisions on
the basis of the data thus acquired. The decisions may be concerned with fur-
ther data needed, procedures required, diagnoses, or treatments. As is probably
well known to the readers, a system such as this is necessary to meet the in-
creasing demand for better medical care in the face of a chronic shortage of
physicians and the rapid growth of clinical knowledge.
The chronic shortage of physicians is not apparent everywhere that medi-
cine is practiced. It is quite apparent, however, in the large public hospitals,
especially city hospitals, and in rural areas. To alleviate this shortage the first
function of CDSS is to relieve the physician of as many data acquisition func-
tions as possible by permitting him to delegate these functions t o paramedical
personnel or to the patient. In addition, the physician is saved further time if,
before he sees the patient, he is given a well-structured summary, complete with
the results of routine laboratory tests and any additional tests indicated by the
initial uork-up.
To alleviate the problems caused by the rapid growth of clinical knowledge,
it is desirable to have appropriate medical information presented to the physi-
cian by the computer. The computer will, in effect, play the role of a con-
sultant. This second function of CDSS will require a large and coherent body
of structured medical information and is therefore much further in the future
than the data acquisition function.
Specifically, the computer system being constructed will: ( 1 ) assist in ac-
quiring patient data, (2 ) present these data in summary form, and (3) suggest
appropriate decisions. This is an iterative process, in that as data are entered,
decisions are made and more data are requested. The early decisions needed
in patient care are concerned with questions as to what tests are t o be performed
and what data are to be acquired.
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