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<body lang=EN-US style='tab-interval:.5in'>
<div class=Section1>
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<td><center><img width=123 height=84 src="ebdss_files/image005.jpg" v:shapes="_x0000_s1028"></center></td>
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<h5 align=center style='margin-top:.25in;margin-right:0in;margin-bottom:6.0pt;
margin-left:0in;text-align:center'><span style='mso-bookmark:_Toc130633260'><span
style='font-size:14.0pt;font-family:"Comic Sans MS";color:navy'>Evidence-Based
Healthcare Decision Support System</span></span><span style='font-size:14.0pt;
font-family:"Comic Sans MS";color:navy'><o:p></o:p></span></h5>
<p class=MsoNormal>The figure below shows a process of building health science
knowledgebases used by evidence-based decision support tools. </p>
<p class=MsoNormal style='margin-bottom:6.0pt'>Note that this figure starts at
the bottom and works it way up.</p>
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<b style='mso-bidi-font-weight:normal'><span style='font-size:9.0pt'><o:p></o:p></span></b></p>
<p class=MsoNormal style='margin-top:0in'><b style='mso-bidi-font-weight:normal'><span
style='font-size:9.0pt'><o:p> </o:p></span></b></p>
</div>
<b style='mso-bidi-font-weight:normal'><span style='font-size:9.0pt;font-family:
"Times New Roman";mso-fareast-font-family:"Times New Roman";mso-ansi-language:
EN-US;mso-fareast-language:EN-US;mso-bidi-language:AR-SA'><br clear=all
style='page-break-before:auto;mso-break-type:section-break'>
</span></b>
<div class=Section2>
<p class=MsoNormal style='margin-top:0in'><b style='mso-bidi-font-weight:normal'><span
style='mso-bidi-font-size:11.0pt'>1)</span></b><span style='mso-bidi-font-size:
11.0pt'> Data about the patient, the patient�s problem, and treatments rendered
are collected using the </span><st1:stockticker><span style='mso-bidi-font-size:
11.0pt'>HIT</span></st1:stockticker><span style='mso-bidi-font-size:11.0pt'>
tools (e.g., Diagnostic Aid, EHR, CPOE, Clinical pathways) are sent to
databases, stripped of patient identifiers, which researchers and other
knowledge workers can access and study. These data include clinical and
financial outcomes, variance information, as well as patient and provider data.<o:p></o:p></span></p>
<p class=MsoNormal><b style='mso-bidi-font-weight:normal'><span
style='mso-bidi-font-size:11.0pt'>2) </span></b><span style='mso-bidi-font-size:
11.0pt'>The stored data and knowledge people have in their heads are
disseminated between loosely networks of collaborating knowledge workers, e.g.,
in consensus groups. <o:p></o:p></span></p>
<p class=MsoNormal><b style='mso-bidi-font-weight:normal'><span
style='mso-bidi-font-size:11.0pt'>3)</span></b><span style='mso-bidi-font-size:
11.0pt'> These collaborators share and discuss their ideas, examine
interventions recommended for treating specific types of people with specific
types of problems (i.e., personalized care models) that have not yet been
validated, and propose research studies.<o:p></o:p></span></p>
<p class=MsoNormal><b style='mso-bidi-font-weight:normal'><span
style='mso-bidi-font-size:11.0pt'>4)</span></b><span style='mso-bidi-font-size:
11.0pt'> <span style='mso-spacerun:yes'>�</span>The collaborators then:<o:p></o:p></span></p>
<p class=MsoNormal style='margin-top:3.0pt;margin-right:0in;margin-bottom:0in;
margin-left:38.9pt;margin-bottom:.0001pt;text-indent:-.25in;mso-list:l10 level1 lfo12;
tab-stops:list 38.6pt'><![if !supportLists]><span style='mso-bidi-font-size:
11.0pt;font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:
Symbol'><span style='mso-list:Ignore'>�<span style='font:7.0pt "Times New Roman"'>
</span></span></span><![endif]><span style='mso-bidi-font-size:11.0pt'>Use
analytic tools to find patterns in the data<o:p></o:p></span></p>
<p class=MsoNormal style='margin-top:3.0pt;margin-right:0in;margin-bottom:0in;
margin-left:38.9pt;margin-bottom:.0001pt;text-indent:-.25in;mso-list:l10 level1 lfo12;
tab-stops:list 38.6pt'><![if !supportLists]><span style='mso-bidi-font-size:
11.0pt;font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:
Symbol'><span style='mso-list:Ignore'>�<span style='font:7.0pt "Times New Roman"'>
</span></span></span><![endif]><span style='mso-bidi-font-size:11.0pt'>Discuss
and challenge one another�s interpretations of the data, and the assumptions
and predictions they make<o:p></o:p></span></p>
<p class=MsoNormal style='margin-top:3.0pt;margin-right:0in;margin-bottom:0in;
margin-left:38.9pt;margin-bottom:.0001pt;text-indent:-.25in;mso-list:l10 level1 lfo12;
tab-stops:list 38.6pt'><![if !supportLists]><span style='mso-bidi-font-size:
11.0pt;font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:
Symbol'><span style='mso-list:Ignore'>�<span style='font:7.0pt "Times New Roman"'>
</span></span></span><![endif]><span style='mso-bidi-font-size:11.0pt'>Build
clinical models reflecting diagnostic and associated treatment processes<o:p></o:p></span></p>
<p class=MsoNormal style='margin-top:3.0pt;margin-right:0in;margin-bottom:0in;
margin-left:38.9pt;margin-bottom:.0001pt;text-indent:-.25in;mso-list:l10 level1 lfo12;
tab-stops:list 38.6pt'><![if !supportLists]><span style='mso-bidi-font-size:
11.0pt;font-family:Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:
Symbol'><span style='mso-list:Ignore'>�<span style='font:7.0pt "Times New Roman"'>
</span></span></span><![endif]><span style='mso-bidi-font-size:11.0pt'>Share
and evolve these models.<o:p></o:p></span></p>
<p class=MsoNormal><b style='mso-bidi-font-weight:normal'><span
style='mso-bidi-font-size:11.0pt'>5) </span></b><span style='mso-bidi-font-size:
11.0pt'>The analyses and discussions result in the validation or the
invalidation of intervention-recommendation models. The validated models are supported
by the scientific evidence showing that particular interventions are safe,
effective, and efficient when used to treat particular types of patients with
particular health problems in particular situations. The invalidated models
have scientific evidence that shows when particular interventions are <i
style='mso-bidi-font-style:normal'>not</i> safe, effective, and efficient when
used to treat particular types of patients with particular health problems in
particular situations; so they are useful for determining when <i
style='mso-bidi-font-style:normal'>not</i> to use a certain intervention. Note
that intervention-recommendation models lacking the scientific evidence to be
either validated or invalidated remain under evaluation.<o:p></o:p></span></p>
<p class=MsoNormal><b style='mso-bidi-font-weight:normal'><span
style='mso-bidi-font-size:11.0pt'>6)</span></b><span style='mso-bidi-font-size:
11.0pt'> The validated and invalidated intervention-recommendation models
become evidence-based practice guidelines.<o:p></o:p></span></p>
<p class=MsoNormal><b style='mso-bidi-font-weight:normal'><span
style='mso-bidi-font-size:11.0pt'>7) </span></b><span style='mso-bidi-font-size:
11.0pt'>The evidence-based practice guidelines are stored in health science
knowledgebases. <o:p></o:p></span></p>
<p class=MsoNormal><b style='mso-bidi-font-weight:normal'><span
style='mso-bidi-font-size:11.0pt'>8) </span></b><span style='mso-bidi-font-size:
11.0pt'>Each evidence-based practice guideline is associated with reference and
instructional materials, which <span class=GramE>are also</span> stored in the
knowledgebase.<o:p></o:p></span></p>
<p class=MsoNormal><b style='mso-bidi-font-weight:normal'><span
style='mso-bidi-font-size:11.0pt'>9)</span></b><span style='mso-bidi-font-size:
11.0pt'> The evidence-based practice guidelines and related materials in the
science knowledgebases are disseminated to authorized stakeholders, where they
are stored locally and accessed for use in the decision support tools,
including Computerized Practice Guidelines and Clinical Pathways (see Figure 1,
#s 4 & 5 and 15 & 16).<o:p></o:p></span></p>
<p class=MsoNormal><b style='mso-bidi-font-weight:normal'><span
style='mso-bidi-font-size:11.0pt'>10)</span></b><span style='mso-bidi-font-size:
11.0pt'> The decision tools send data about the care process and outcome to the
research databases, as per step #1, which is used to create new and modify
existing practice guidelines. This is an ongoing feedback loop leading to
continually improving guidelines and outcomes.<o:p></o:p></span></p>
</div>
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</span>
<div class=Section3>
<p class=MsoNormal><o:p> </o:p></p>
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