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A standards-based, service-oriented architecture for clinical decision support (CDS) has the potential to significantly enhance CDS scalability and robustness. To enable such a CDS architecture, the Health Level 7 CDS Work Group reviewed the literature, hosted multi-stakeholder discussions, and consulted domain experts to identify and prioritize the(More)
Clinical coding and classification processes transform natural language descriptions in clinical text into data that can subsequently be used for clinical care, research, and other purposes. This systematic literature review examined studies that evaluated all types of automated coding and classification systems to determine the performance of such systems.(More)
The Arden Syntax is one of a few knowledge representation languages currently in use for clinical decision support. While some of these languages are being used in active patient care settings, none have gained widespread acceptance as a clinical tool. Prior attempts to represent temporally complex care plans in the Arden Syntax have revealed difficulties(More)
Because clinical databases vary in structure, access methods and vocabulary used to represent data, the Arden Syntax does not define a standard model for querying databases. Consequently, database queries are encoded in ad hoc ways and enclosed in "curly braces" in Medical Logic Modules (MLMs). However, the nonstandard representation of queries impairs(More)
BACKGROUND Prior studies offer conflicting findings on whether Alzheimer's disease (AD) is associated with an increased risk of hospitalization. METHODS We investigated AD and hospitalization in the Washington Heights-Inwood Columbia Aging Project (WHICAP), a community-based study of 2,334 elders in New York City. In 1996, an electronic medical records(More)
We began implementation of a medical decision support system (MDSS) at the Columbia-Presbyterian Medical Center (CPMC) using the Arden Syntax in 1992. The Clinical Event Monitor which executes the Medical Logic Modules (MLMs) runs on a mainframe computer. Data are stored in a relational database and accessed via PL/I programs known as Data Access Modules(More)
The issues and implementation of a clinical event monitor are described. An event monitor generates messages for providers, patients, and organizations based on clinical events and patient data. For example, an order for a medication might trigger the generation of a warning about a drug interaction. A model based on the active database literature has as(More)
Computer-based clinical decision support systems (CDSSs) are often implemented at a cluster level, but standard statistical methods for sample estimation and analysis may not be appropriate for such studies. This review aims to determine whether the design and analysis methods of cluster-based studies were adequately addressed in reports of CDSS studies. We(More)
Clinical decision support (CDS) in electronic prescribing (eRx) systems can improve the safety, quality, efficiency, and cost-effectiveness of care. However, at present, these potential benefits have not been fully realized. In this consensus white paper, we set forth recommendations and action plans in three critical domains: (1) advances in system(More)
Despite their potential to significantly improve health care, advanced clinical decision support (CDS) capabilities are not widely available in the clinical setting. An important reason for this limited availability of CDS capabilities is the application-specific and institution-specific nature of most current CDS implementations. Thus, a critical need for(More)