Computerized clinical decision support system for a public health program for the prevention of preeclampsia

摘要

In this article we describe the development of the prototype of the "Expert System for the Preeclampsia Prevention Program" (ESPPP), a computer-based clinical decision support system that suggests the most appropriate diagnostic and therapeutic strategies in order to deliver the best possible individualized clinical practice based on evidences in the realm of hypertensive disorders of pregnancy (HDP). ESPPP was designed to be used to train physicians and to guide them to accurately perform all the activities of a public health program ("Preeclampsia Prevention Program" or PPP) while fulfilling the data base of the epidemiological surveillance system for this program. ESPRE (expert system for the diagnosis an treatment of preeclampsia), a previously developed decision support system, was readily adopted by physicians who believed it would have a positive impact on the quality and efficiency of care, however, dissatisfaction with system capabilities (such as non-updateability of rules, time consumption and some resources), for both physicians and PPP's, authorities moved us to develop another system with an improved rules-editor and better resources. ESPPP consists on two main modules: The Knowledge Base Editor, fed with the clinical based evidences and guidelines and, the Diagnostic/Therapeutical Application, which guides the doctor on the assessment of and recommendations for the patient. ESPPP applies pragmatic criteria based on evidences and PPP's guidelines for diagnosing, classifying and suggesting the appropriate treatment of the HDP and their complications. This system guides the users for rapid, easy and systematically collecting patient information, and based on those items that leads to the possible diagnose and treatment for that patient. We will describe the design, modules and capabilities. Preliminary results and plans for further analysis are reported.