In this section, the current state of decision support systems in health is reviewed. It considers, health professionals role in decision-making, how health professionals are assisted with decision tools and finally assisting patients with decision tools.
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2.3.3.1 Health professionals role in decision-making
The expertise of the health professional rather than computational methods helped to diagnose patients with a heart condition in the paper by Salustri and Trambaiolo (2002).
In a 2003 patent, a diabetes management system was proposed which incorporated the use of a mobile phone to transmit glucometer results to a health professional. The health professional then provided advice to the patient regarding the type of treatment they should administer Moerman et al. (2003). Again in this scenario, support is provided through the expert opinions of health professionals rather than through devices.
2.3.3.2 Assisting health professionals with decision tools
Sullivan and Wyatt (2005a) described an example of how decision support tools were being used to aid and complement the clinical diagnosis of a doctor within a GP surgery. A clinical information system providing decision support to the health professional (GP) was described. The article described how informatics resources could be used in patient management by considering the patient‘s overall health rather than only the symptoms presented by the patient at a particular consultation. The electronic system provided a means of highlighting issues through the use of prompts. In addition, alerts could also be triggered by the system informing the doctor that the new symptoms recorded could also affect the management of the patient‘s long term condition, hence allowing ―proactive‖ rather than reactive care. Sullivan and Wyatt (2005a) further discuss the advantages of computerised guidelines over paper ones. These included accessibility of information; reduction of ambiguity of information; customizing guidelines to suit the patient; and sending prompts to the doctor. In summary, Sullivan and Wyatt (2005a) give a warning that although a variety of other information sources are available to patients, they must not be used in isolation and a doctor was still needed to help clarify issues.
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Liu et al. (2006) considered a decision tool as ―an active knowledge resource utilizing patient data to generate case-specific advice supporting decision-making about patients by health professionals, patients or those caring for them‖. This definition suggested that the use of decision tools within health care could be extended from a sole use by health professionals alone to others. Liu et al. (2006) provide some reasons why decision tools may not have been used in the past. These included: Health professionals already operating best practice and using a DSS would not enhance patient treatment.
The output provided by the DSS was inaccurate or it did not provide enough details to influence health professionals in changing their practice.
The DSS did not produce a useful output in the time health professionals needed to make a decision.
2.3.3.3 Assisting patients with decision tools
Ruland (2004) noted that patients should be involved in decision-making on their health, but that the issue of safety needed to be considered. Literature suggested that the main causes of error relate to unavailability of relevant data; ―misinterpretation of data‖ and ―ineffective communication‖ (Reason, 1992). Ruland (2004) considered the more recent development of decision aids that have helped to support shared decision-making between patients and health professionals. Decision aids should allow people to choose the appropriate option, based on the information available, by improving their knowledge of the condition, but without at the same time raising their anxiety levels (O‘Connor et al. 1999).
Gustafson et al. (1999) also noted the need for information to aid people diagnosed with prolonged conditions in their decision-making. Gustafson et al. (1999) described a computerised DSS that enabled patients to access multiple information sources in order to make informed decisions.
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The PDS/Ferraris (2004) report about the device for measuring PEF noted that patients could be trained in interpreting the results obtained based on guidelines provided by health professionals.
Burkhart et al. (2007) discussed a manual decision support system for managing asthma. A written guideline in the form of a traffic light system was provided for each person in the study for them to manually compare actual PEF with expected PEF results so that necessary actions could be taken. The result range which was specific to each individual was based on their recordings in the diary. A PEF value below 50% of the individual‘s personal best was classified into the ‗red‘ region and it signified that medical assistance was urgently needed, while a PEF value between 80% and 100% of their personal best was classified into the ‗green‘ region as it represented good asthma management. This type of monitoring allows for real-time decision support for the patient.
Similarly, in a study by Apostolopoulos et al. (2007) investigating self management of diabetes, where patients were trained in how to draw conclusions and manage their condition from their blood glucose test results on a daily basis. After transferring the results, it was not clear in the report of the study whether health professionals could then provide real-time advice or whether patients received feedback at a later date. It seemed that the primary decision-maker was the patient since monitoring was on a daily basis.