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Gilad J. Kuperman, Richard M. Reichley, Thomas C. Bailey, Using Commercial Knowledge Bases for Clinical Decision Support: Opportunities, Hurdles, and Recommendations, Journal of the American Medical Informatics Association, Volume 13, Issue 4, July 2006, Pages 369–371, https://doi.org/10.1197/jamia.M2055
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The quality and safety of health care leaves much to be desired.1,2 Automated clinical decision support (CDS) tools embedded in clinical information systems (CISs) such as computer provider order entry (CPOE) and electronic health records (EHR) applications have the potential to improve care and should be part of any comprehensive approach to improve quality.3,4,5,6 Medication prescribing is a component of health care with well documented quality and safety problems that can be improved by CDS.7,8,9
Medication-related CDS requires that pharmaceutical knowledge be represented in a computable, explicit and unambiguous form. Creating an automated representation of medical knowledge often is the most time consuming step in the development of a CDS system and is known as the “knowledge acquisition bottleneck.”10 For a time, it was hoped that the move toward explicit guidelines in medicine would decrease the knowledge acquisition effort,11 but that has not happened.12 Experiments on data sharing from over a decade ago have not progressed.13 As a result, just a few organizations, primarily academic medical centers, are creating rules and benefiting from CDS,14 but most health care organizations do not have the expertise or resources to create such knowledge bases themselves.