The implementation of clinical decision support systems (CDSSs) as an intervention to foster clinical practice change is affected by many factors. Key factors include those associated with behavioral ...change and those associated with technology acceptance. However, the literature regarding these subjects is fragmented and originates from two traditionally separate disciplines: implementation science and technology acceptance.
Our objective is to propose an integrated framework that bridges the gap between the behavioral change and technology acceptance aspects of the implementation of CDSSs.
We employed an iterative process to map constructs from four contributing frameworks-the Theoretical Domains Framework (TDF); the Consolidated Framework for Implementation Research (CFIR); the Human, Organization, and Technology-fit framework (HOT-fit); and the Unified Theory of Acceptance and Use of Technology (UTAUT)-and the findings of 10 literature reviews, identified through a systematic review of reviews approach.
The resulting framework comprises 22 domains: agreement with the decision algorithm; attitudes; behavioral regulation; beliefs about capabilities; beliefs about consequences; contingencies; demographic characteristics; effort expectancy; emotions; environmental context and resources; goals; intentions; intervention characteristics; knowledge; memory, attention, and decision processes; patient-health professional relationship; patient's preferences; performance expectancy; role and identity; skills, ability, and competence; social influences; and system quality. We demonstrate the use of the framework providing examples from two research projects.
We proposed BEAR (BEhavior and Acceptance fRamework), an integrated framework that bridges the gap between behavioral change and technology acceptance, thereby widening the view established by current models.
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•Computer-based clinical decision support (CDS) has had suboptimal adoption and use.•Many dimensions of the problem, that could potentially benefit from formal approach.•Models or ...frameworks can identify aspects or parameters to study.•Can be used to compare different efforts.•Propose need for multiple models or frameworks – for different aspects – rather than a single comprehensive model.
Computer-based clinical decision support (CDS) has been pursued for more than five decades. Despite notable accomplishments and successes, wide adoption and broad use of CDS in clinical practice has not been achieved. Many issues have been identified as being partially responsible for the relatively slow adoption and lack of impact, including deficiencies in leadership, recognition of purpose, understanding of human interaction and workflow implications of CDS, cognitive models of the role of CDS, and proprietary implementations with limited interoperability and sharing.
To address limitations, many approaches have been proposed and evaluated, drawing on theoretical frameworks, as well as management, technical and other disciplines and experiences. It seems clear, because of the multiple perspectives involved, that no single model or framework is adequate to encompass these challenges. This Viewpoint paper seeks to review the various foci of CDS and to identify aspects in which theoretical models and frameworks for CDS have been explored or could be explored and where they might be expected to be most useful.
Decision support tools, usually considered to be software-based, may be an important part of the quest for evidence-based decision-making in agriculture to improve productivity and environmental ...outputs. These tools can lead users through clear steps and suggest optimal decision paths or may act more as information sources to improve the evidence base for decisions. Yet, despite their availability in a wide range of formats, studies in several countries have shown uptake to be disappointingly low. This paper uses a mixed methods approach to investigate the factors affecting the uptake and use of decision support tools by farmers and advisers in the UK. Through a combination of qualitative interviews and quantitative surveys, we found that fifteen factors are influential in convincing farmers and advisers to use decision support tools, which include usability, cost-effectiveness, performance, relevance to user, and compatibility with compliance demands. This study finds a plethora of agricultural decision support tools in operation in the UK, yet, like other studies, shows that their uptake is low. A better understanding of the fifteen factors identified should lead to more effective design and delivery of tools in the future.
•A search of DST available for use by UK farmers and advisors found 395 tools•49% of farmers used some kind of decision support tool to inform decisions.•All advisers used some form of decision support tools to inform decisions.•Modes found most useful for farmers – software (28%), paper-based (22%), apps (10%).•Fifteen characteristics were found to be influential for effective DST.
Objective: Thus far, most applications in precision mental health have not been evaluated prospectively. This article presents the results of a prospective randomized-controlled trial investigating ...the effects of a digital decision support and feedback system, which includes two components of patient-specific recommendations: (a) a clinical strategy recommendation and (b) adaptive recommendations for patients at risk for treatment failure. Method: Therapist-patient dyads (N = 538) in a cognitive behavioral therapy outpatient clinic were randomized to either having access to a decision support system (intervention group; n = 335) or not (treatment as usual; n = 203). First, treatment strategy recommendations (problem-solving, motivation-oriented, or a mix of both strategies) for the first 10 sessions were evaluated. Second, the effect of psychometric feedback enhanced with clinical problem-solving tools on treatment outcome was investigated. Results: The prospective evaluation showed a differential effect size of about 0.3 when therapists followed the recommended treatment strategy in the first 10 sessions. Moreover, the linear mixed models revealed therapist symptom awareness and therapist attitude and confidence as significant predictors of an outcome as well as therapist-rated usefulness of feedback as a significant moderator of the feedback-outcome and the not on track-outcome associations. However, no main effects were found for feedback. Conclusions: The results demonstrate the importance of prospective studies and the high-quality implementation of digital decision support tools in clinical practice. Therapists seem to be able to learn from such systems and incorporate them into their clinical practice to enhance patient outcomes, but only when implementation is successful.
What is the public health significance of this article?
This randomized clinical implementation trial provides insight into the evaluation of a clinical decision support and feedback system including personalized pretherapy recommendations and enhanced psychometric feedback during treatment. As it is one of the first decision systems to have been implemented and evaluated prospectively in mental health, this study helps to improve such systems designed to support and change the way psychotherapy is conducted. The results underscore the importance of high-quality implementation of digital decision support tools in clinical practice.
Clinical Decision Support Systems (CDSS) have been implemented in almost all healthcare settings. Laboratory medicine (LM), is one of the most important structured health data stores, but efforts are ...still needed to clarify the use and scope of these tools, especially in the laboratory setting. The aim is to clarify CDSS concept in LM, in the last decade. There is no consensus on the definition of CDSS in LM. A theoretical definition of CDSS in LM should capture the aim of driving significant improvements in LM mission, prevention, diagnosis, monitoring, and disease treatment. We identified the types, workflow and data sources of CDSS. The main applications of CDSS in LM were diagnostic support and clinical management, patient safety, workflow improvements, and cost containment. Laboratory professionals, with their expertise in quality improvement and quality assurance, have a chance to be leaders in CDSS.
•Machine learning (ML)-based crop yield prediction papers have been synthesized.•We selected 50 ML-based papers and later, 30 deep learning-based papers.•Most used features are temperature, rainfall, ...and soil type.•The most widely used ML algorithm is Neural Networks.•The most widely used deep learning algorithm is CNN.
Machine learning is an important decision support tool for crop yield prediction, including supporting decisions on what crops to grow and what to do during the growing season of the crops. Several machine learning algorithms have been applied to support crop yield prediction research. In this study, we performed a Systematic Literature Review (SLR) to extract and synthesize the algorithms and features that have been used in crop yield prediction studies. Based on our search criteria, we retrieved 567 relevant studies from six electronic databases, of which we have selected 50 studies for further analysis using inclusion and exclusion criteria. We investigated these selected studies carefully, analyzed the methods and features used, and provided suggestions for further research. According to our analysis, the most used features are temperature, rainfall, and soil type, and the most applied algorithm is Artificial Neural Networks in these models. After this observation based on the analysis of machine learning-based 50 papers, we performed an additional search in electronic databases to identify deep learning-based studies, reached 30 deep learning-based papers, and extracted the applied deep learning algorithms. According to this additional analysis, Convolutional Neural Networks (CNN) is the most widely used deep learning algorithm in these studies, and the other widely used deep learning algorithms are Long-Short Term Memory (LSTM) and Deep Neural Networks (DNN).
Clinical decision support system, which uses advanced data mining techniques to help clinician make proper decisions, has received considerable attention recently. The advantages of clinical decision ...support system include not only improving diagnosis accuracy but also reducing diagnosis time. Specifically, with large amounts of clinical data generated everyday, naïve Bayesian classification can be utilized to excavate valuable information to improve a clinical decision support system. Although the clinical decision support system is quite promising, the flourish of the system still faces many challenges including information security and privacy concerns. In this paper, we propose a new privacy-preserving patient-centric clinical decision support system, which helps clinician complementary to diagnose the risk of patients' disease in a privacy-preserving way. In the proposed system, the past patients' historical data are stored in cloud and can be used to train the naïve Bayesian classifier without leaking any individual patient medical data, and then the trained classifier can be applied to compute the disease risk for new coming patients and also allow these patients to retrieve the top-k disease names according to their own preferences. Specifically, to protect the privacy of past patients' historical data, a new cryptographic tool called additive homomorphic proxy aggregation scheme is designed. Moreover, to leverage the leakage of naïve Bayesian classifier, we introduce a privacy-preserving top-k disease names retrieval protocol in our system. Detailed privacy analysis ensures that patient's information is private and will not be leaked out during the disease diagnosis phase. In addition, performance evaluation via extensive simulations also demonstrates that our system can efficiently calculate patient's disease risk with high accuracy in a privacy-preserving way.
Breast cancer oncologists are challenged to personalize care with rapidly changing scientific evidence, drug approvals, and treatment guidelines. Artificial intelligence (AI) clinical ...decision-support systems (CDSSs) have the potential to help address this challenge. We report here the results of examining the level of agreement (concordance) between treatment recommendations made by the AI CDSS Watson for Oncology (WFO) and a multidisciplinary tumor board for breast cancer.
Treatment recommendations were provided for 638 breast cancers between 2014 and 2016 at the Manipal Comprehensive Cancer Center, Bengaluru, India. WFO provided treatment recommendations for the identical cases in 2016. A blinded second review was carried out by the center's tumor board in 2016 for all cases in which there was not agreement, to account for treatments and guidelines not available before 2016. Treatment recommendations were considered concordant if the tumor board recommendations were designated ‘recommended’ or ‘for consideration’ by WFO.
Treatment concordance between WFO and the multidisciplinary tumor board occurred in 93% of breast cancer cases. Subgroup analysis found that patients with stage I or IV disease were less likely to be concordant than patients with stage II or III disease. Increasing age was found to have a major impact on concordance. Concordance declined significantly (P ≤ 0.02; P < 0.001) in all age groups compared with patients <45 years of age, except for the age group 55–64 years. Receptor status was not found to affect concordance.
Treatment recommendations made by WFO and the tumor board were highly concordant for breast cancer cases examined. Breast cancer stage and patient age had significant influence on concordance, while receptor status alone did not. This study demonstrates that the AI clinical decision-support system WFO may be a helpful tool for breast cancer treatment decision making, especially at centers where expert breast cancer resources are limited.
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