<s>
A	O
clinical	B-Application
decision	I-Application
support	I-Application
system	I-Application
(	O
CDSS	O
)	O
is	O
a	O
health	O
information	O
technology	O
that	O
provides	O
clinicians	O
,	O
staff	O
,	O
patients	O
,	O
or	O
other	O
individuals	O
with	O
knowledge	O
and	O
person-specific	O
information	O
,	O
to	O
help	O
health	O
and	O
health	O
care	O
.	O
</s>
<s>
Robert	O
Hayward	O
of	O
the	O
Centre	O
has	O
proposed	O
a	O
working	O
definition	O
for	O
Health	O
Evidence	O
:	O
"	O
Clinical	B-Application
decision	I-Application
support	I-Application
systems	I-Application
link	O
health	O
observations	O
with	O
health	O
knowledge	O
to	O
influence	O
health	O
choices	O
by	O
clinicians	O
for	O
improved	O
health	O
care	O
"	O
.	O
</s>
<s>
CDSSs	O
constitute	O
a	O
major	O
topic	O
in	O
artificial	B-Application
intelligence	I-Application
in	O
medicine	O
.	O
</s>
<s>
A	O
clinical	B-Application
decision	I-Application
support	I-Application
system	I-Application
is	O
an	O
active	O
knowledge	O
system	O
that	O
uses	O
variables	O
of	O
patient	O
data	O
to	O
produce	O
advice	O
regarding	O
health	O
care	O
.	O
</s>
<s>
This	O
implies	O
that	O
a	O
CDSS	O
is	O
simply	O
a	O
decision	B-Application
support	I-Application
system	I-Application
that	O
is	O
focused	O
on	O
using	O
knowledge	O
management	O
.	O
</s>
<s>
An	O
example	O
of	O
how	O
a	O
clinical	B-Application
decision	I-Application
support	I-Application
system	I-Application
might	O
be	O
used	O
by	O
a	O
clinician	O
is	O
a	O
diagnosis	O
decision	B-Application
support	I-Application
system	I-Application
(	O
DDSS	O
)	O
.	O
</s>
<s>
As	O
of	O
2012	O
,	O
it	O
has	O
been	O
claimed	O
that	O
decision	B-Application
support	I-Application
will	O
begin	O
to	O
replace	O
clinicians	O
in	O
common	O
tasks	O
in	O
the	O
future	O
.	O
</s>
<s>
call	O
an	O
ambulance	B-Application
,	O
or	O
see	O
a	O
general	O
practitioner	O
on	O
the	O
next	O
working	O
day	O
)	O
.	O
</s>
<s>
An	O
expression	O
language	O
such	O
as	O
GELLO	B-Language
or	O
CQL	O
(	O
Clinical	O
Quality	O
Language	O
)	O
is	O
needed	O
for	O
expressing	O
knowledge	O
artefacts	O
in	O
a	O
computable	O
manner	O
.	O
</s>
<s>
CDSSs	O
which	O
do	O
not	O
use	O
a	O
knowledge	O
base	O
use	O
a	O
form	O
of	O
artificial	B-Application
intelligence	I-Application
called	O
machine	O
learning	O
,	O
which	O
allow	O
computers	O
to	O
learn	O
from	O
past	O
experiences	O
and/or	O
find	O
patterns	O
in	O
clinical	O
data	O
.	O
</s>
<s>
As	O
of	O
2012	O
,	O
three	O
types	O
of	O
non-knowledge-based	O
systems	O
are	O
support-vector	B-Algorithm
machines	I-Algorithm
,	O
artificial	B-Architecture
neural	I-Architecture
networks	I-Architecture
and	O
genetic	B-Algorithm
algorithms	I-Algorithm
.	O
</s>
<s>
Artificial	B-Architecture
neural	I-Architecture
networks	I-Architecture
use	O
nodes	O
and	O
weighted	O
connections	O
between	O
them	O
to	O
analyse	O
the	O
patterns	O
found	O
in	O
patient	O
data	O
to	O
derive	O
associations	O
between	O
symptoms	O
and	O
a	O
diagnosis	O
.	O
</s>
<s>
Genetic	B-Algorithm
algorithms	I-Algorithm
are	O
based	O
on	O
simplified	O
evolutionary	O
processes	O
using	O
directed	O
selection	O
to	O
achieve	O
optimal	O
CDSS	O
results	O
.	O
</s>
<s>
They	O
are	O
functionally	O
similar	O
to	O
neural	B-Architecture
networks	I-Architecture
in	O
that	O
they	O
are	O
also	O
"	O
black	O
boxes	O
"	O
that	O
attempt	O
to	O
derive	O
knowledge	O
from	O
patient	O
data	O
.	O
</s>
<s>
An	O
example	O
of	O
a	O
non-knowledge-based	O
CDSS	O
is	O
a	O
web	O
server	O
developed	O
using	O
a	O
support	B-Algorithm
vector	I-Algorithm
machine	I-Algorithm
for	O
the	O
prediction	O
of	O
gestational	O
diabetes	O
in	O
Ireland	O
.	O
</s>
<s>
Through	O
these	O
initiatives	O
,	O
more	O
hospitals	O
and	O
clinics	O
are	O
integrating	O
electronic	B-Application
medical	I-Application
records	I-Application
(	O
EMRs	O
)	O
and	O
computerized	O
physician	O
order	O
entry	O
(	O
CPOE	O
)	O
within	O
their	O
health	O
information	O
processing	O
and	O
storage	O
.	O
</s>
<s>
Consequently	O
,	O
the	O
Institute	O
of	O
Medicine	O
(	O
IOM	O
)	O
promoted	O
the	O
usage	O
of	O
health	O
information	O
technology	O
,	O
including	O
clinical	B-Application
decision	I-Application
support	I-Application
systems	I-Application
,	O
to	O
advance	O
the	O
quality	O
of	O
patient	O
care	O
.	O
</s>
<s>
A	O
2014	O
systematic	O
review	O
did	O
not	O
find	O
a	O
benefit	O
in	O
terms	O
of	O
risk	O
of	O
death	O
when	O
the	O
CDSS	O
was	O
combined	O
with	O
the	O
electronic	B-Application
health	I-Application
record	I-Application
.	O
</s>
<s>
A	O
2005	O
systematic	O
review	O
found	O
...	O
"	O
Decision	B-Application
support	I-Application
systems	I-Application
significantly	O
improved	O
clinical	O
practice	O
in	O
68%	O
of	O
trials.	O
"	O
</s>
<s>
The	O
CDSS	O
features	O
associated	O
with	O
success	O
included	O
integration	O
into	O
the	O
clinical	O
workflow	O
rather	O
than	O
as	O
a	O
separate	O
log-in	O
or	O
screen.	O
,	O
electronic	O
rather	O
than	O
paper-based	O
templates	O
,	O
providing	O
decision	B-Application
support	I-Application
at	O
the	O
time	O
and	O
location	O
of	O
care	O
rather	O
than	O
prior	O
and	O
providing	O
care	O
recommendations	O
.	O
</s>
<s>
Clinical	B-Application
decision	I-Application
support	I-Application
systems	I-Application
face	O
steep	O
technical	O
challenges	O
in	O
a	O
number	O
of	O
areas	O
.	O
</s>
<s>
While	O
it	O
has	O
been	O
shown	O
that	O
clinicians	O
require	O
explanations	O
of	O
Machine	O
Learning-Based	O
CDSS	O
,	O
in	O
order	O
to	O
able	O
to	O
understand	O
and	O
trust	O
their	O
suggestions	O
,	O
there	O
is	O
an	O
overall	O
distinct	O
lack	O
of	O
application	O
of	O
explainable	O
Artificial	B-Application
Intelligence	I-Application
in	O
the	O
context	O
of	O
CDSS	O
,	O
thus	O
adding	O
another	O
barrier	O
to	O
the	O
adoption	O
of	O
these	O
systems	O
.	O
</s>
<s>
In	O
2004	O
,	O
it	O
was	O
stated	O
that	O
the	O
process	O
of	O
gathering	O
clinical	O
data	O
and	O
medical	O
knowledge	O
and	O
putting	O
them	O
into	O
a	O
form	O
that	O
computers	O
can	O
manipulate	O
to	O
assist	O
in	O
clinical	O
decision-support	B-Application
is	O
"	O
still	O
in	O
its	O
infancy	O
"	O
.	O
</s>
<s>
In	O
addition	O
to	O
being	O
laborious	O
,	O
integration	O
of	O
new	O
data	O
can	O
sometimes	O
be	O
difficult	O
to	O
quantify	O
or	O
incorporate	O
into	O
the	O
existing	O
decision	B-Application
support	I-Application
schema	O
,	O
particularly	O
in	O
instances	O
where	O
different	O
clinical	O
papers	O
may	O
appear	O
conflicting	O
.	O
</s>
<s>
The	O
evaluation	O
benchmark	O
for	O
a	O
CDSS	O
depends	O
on	O
the	O
system	O
's	O
goal	O
:	O
for	O
example	O
,	O
a	O
diagnostic	O
decision	B-Application
support	I-Application
system	I-Application
may	O
be	O
rated	O
based	O
upon	O
the	O
consistency	O
and	O
accuracy	O
of	O
its	O
classification	O
of	O
disease	O
(	O
as	O
compared	O
to	O
physicians	O
or	O
other	O
decision	B-Application
support	I-Application
systems	I-Application
)	O
.	O
</s>
<s>
Implementing	O
EHRs	B-Application
was	O
an	O
inevitable	O
challenge	O
.	O
</s>
<s>
However	O
,	O
challenges	O
in	O
implementing	O
electronic	B-Application
health	I-Application
records	I-Application
(	O
EHRs	B-Application
)	O
have	O
received	O
some	O
attention	O
.	O
</s>
<s>
Still	O
,	O
less	O
is	O
known	O
about	O
transitioning	O
from	O
legacy	B-Device
EHRs	B-Application
to	O
newer	O
systems	O
.	O
</s>
<s>
EHRs	B-Application
are	O
a	O
way	O
to	O
capture	O
and	O
utilise	O
real-time	O
data	O
to	O
provide	O
high-quality	O
patient	O
care	O
,	O
ensuring	O
efficiency	O
and	O
effective	O
use	O
of	O
time	O
and	O
resources	O
.	O
</s>
<s>
Since	O
"	O
clinical	B-Application
decision	I-Application
support	I-Application
systems	I-Application
(	O
CDSS	O
)	O
are	O
computer	O
systems	O
designed	O
to	O
impact	O
clinician	O
decision	O
making	O
about	O
individual	O
patients	O
at	O
the	O
point	O
in	O
time	O
that	O
these	O
decisions	O
are	O
made	O
"	O
,	O
it	O
is	O
clear	O
that	O
it	O
would	O
be	O
beneficial	O
to	O
have	O
a	O
fully	O
integrated	O
CDSS	O
and	O
EHR	O
.	O
</s>
<s>
Three	O
areas	O
that	O
can	O
be	O
addressed	O
with	O
the	O
implementation	O
of	O
CDSS	O
and	O
Electronic	B-Application
Health	I-Application
Records	I-Application
(	O
EHRs	B-Application
)	O
,	O
are	O
:	O
</s>
<s>
The	O
measurable	O
benefits	O
of	O
clinical	B-Application
decision	I-Application
support	I-Application
systems	I-Application
on	O
physician	O
performance	O
and	O
patient	O
outcomes	O
remain	O
the	O
subject	O
of	O
ongoing	O
research	O
.	O
</s>
<s>
Implementing	O
electronic	B-Application
health	I-Application
records	I-Application
(	O
EHR	O
)	O
in	O
healthcare	O
settings	O
incurs	O
challenges	O
;	O
none	O
more	O
important	O
than	O
maintaining	O
efficiency	O
and	O
safety	O
during	O
rollout	O
,	O
but	O
in	O
order	O
for	O
the	O
implementation	O
process	O
to	O
be	O
effective	O
,	O
an	O
understanding	O
of	O
the	O
EHR	O
users	O
 '	O
perspectives	O
is	O
key	O
to	O
the	O
success	O
of	O
EHR	O
implementation	O
projects	O
.	O
</s>
<s>
As	O
of	O
July	O
2015	O
,	O
the	O
planned	O
transition	O
to	O
EHRs	B-Application
in	O
Australia	O
is	O
facing	O
difficulties	O
.	O
</s>
<s>
Most	O
healthcare	O
facilities	O
are	O
still	O
running	O
completely	O
paper-based	O
systems	O
;	O
some	O
are	O
in	O
a	O
transition	O
phase	O
of	O
scanned	O
EHRs	B-Application
or	O
moving	O
towards	O
such	O
a	O
transition	O
phase	O
.	O
</s>
<s>
(	O
However	O
,	O
on	O
the	O
other	O
hand	O
,	O
the	O
UK	O
's	O
National	O
Health	O
Service	O
is	O
also	O
centrally	O
administered	O
,	O
and	O
its	O
National	B-Application
Programme	I-Application
for	I-Application
IT	I-Application
in	O
the	O
2000s	O
,	O
which	O
included	O
EHRs	B-Application
in	O
its	O
remit	O
,	O
was	O
an	O
expensive	O
disaster	O
.	O
)	O
</s>
<s>
SA	O
is	O
in	O
the	O
process	O
of	O
implementing	O
"	O
Enterprise	O
patient	B-Application
administration	I-Application
system	I-Application
(	O
EPAS	O
)	O
"	O
.	O
</s>
<s>
With	O
the	O
largest	O
health	O
system	O
in	O
the	O
country	O
and	O
a	O
federated	O
rather	O
than	O
a	O
centrally	O
administered	O
model	O
,	O
New	O
South	O
Wales	O
is	O
making	O
consistent	O
progress	O
towards	O
statewide	O
implementation	O
of	O
EHRs	B-Application
.	O
</s>
<s>
The	O
EBMEDS	O
Clinical	B-Application
Decision	I-Application
Support	I-Application
service	O
provided	O
by	O
Duodecim	O
Medical	O
Publications	O
Ltd	O
is	O
used	O
by	O
more	O
than	O
60%	O
of	O
Finnish	O
public	O
health	O
care	O
doctors	O
.	O
</s>
<s>
A	O
study	O
in	O
the	O
UK	O
tested	O
the	O
Salford	O
Medication	O
Safety	O
Dashboard	O
(	O
SMASH	O
)	O
,	O
a	O
web-based	O
CDSS	O
application	O
to	O
help	O
GPs	O
and	O
pharmacists	O
find	O
people	O
in	O
their	O
electronic	B-Application
health	I-Application
records	I-Application
who	O
might	O
face	O
safety	O
hazards	O
due	O
to	O
prescription	O
errors	O
.	O
</s>
