Search

The widespread adoption of Information and Communication Technologies (ICT) in the healthcare industries have given rise to the increase in the generation of valuable Electronic Health Records (EHRs). This brings potential in the secondary uses of EHRs for research, analysis and decision making support. Clinical Decision Support System (CDSS) has become an integral tool in assisting healthcare professionals, make well-informed decisions. However, CDSSs are plagued with issues of effectiveness in delivering recommendations and support. With ongoing concerns regarding the limitations of evidence generated from systematic studies and effectiveness of CDSS to offer recommendations, a Practice-based evidence (PBE) approach to decision making is proposed. In this study, we present a system design framework that models and implements a PBE-approached CDSS. Such a CDSS design leverages on practical evidence in the form of EHRs where health records of patients are inferred and potentially used to support decision making for other similar patient types. Our design approach includes identifying suitable data sources and integration tool that packages various sources of health records as evidence for decision support systems. We present a prototype of our PBE-approached CDSS that provides patient-centric statistical information and prediction modelling.

This thesis studies the conceptualisation and evaluation of a Practice-Based Evidence approach to decision making in healthcare. It examines the existing ICT architecture of a public hospital in Singapore to design a decision support system that leverages practical clinical evidence meaningfully captured in electronic health records. In doing so, healthcare professionals are supported in decision making through findings from past similar patients that can be generalised to the current patient population.

The adoption of Electronic Health Record (EHR) systems has been widespread both locally and globally. The result of such adoptions has been the generation of huge amounts of digital healthcare data, assets which are valuable towards providing better care and management of patients. While studies conducted on secondary use of EHR data have found to be beneficial, such use is still in its infancy. As such, a complementary approach of Practice-based evidence (PBE) to decision making which leverages on EHR data as practical clinical evidence has been proposed. As part of evaluating the feasibility of PBE approach to decision making, this paper aims at studying the perception Singapore doctors have on the clinical benefits of using EHR systems and the usefulness of EHR data to assist with decision making. The findings from this study will aid in understanding the potential of utilising EHR as practical clinical evidence in the approach of PBE to decision making.

Effective decision-making plays an important role in promoting optimal care delivery. Factors such as availability of data, timely access to data and organised information greatly influences the quality of decision-making as illustrated in a causal loop diagram. The contribution of practice-based evidence thus aims at structuring an approach where healthcare professionals can be consistently assisted in making effective decisions during routine primary care. Through a practice-based evidence ehealth scenario and a data-flow diagram of clinical systems in a public hospital from Singapore, we have identified the importance of leveraging electronic health records as ideal resources in the pursuit of improving healthcare decision-making.

The readily available and accessible large collection of electronic health records has encouraged an increasing interest on its secondary use. It is especially true for the approach of practice-based evidence where the secondary use of EHR data, collected during routine care, has the potential to improve healthcare professionals’ decision-making capabilities and effectiveness, and broadens their knowledge regarding treatments, medications and clinical conditions. Through effective and quality decision-making, healthcare professionals are able to deliver care that positively improves patient health outcomes in a cost-effective and safe manner. However, privacy and security breaches potentially impact the integrity of data captured in electronic health records, and this invalidates its perceived usefulness in providing evidence to support care. In order to design a secure and effective EHR system for the adoption of practice-based evidence approaches, recommendations for privacy and security measures can follow the security control protocol of preventive, detective and corrective control. Within each control, different security solutions are recommended so that security design is truly holistic.

Decision-making is such an integral aspect in health care routine that the ability to make the right decisions at crucial moments can lead to patient health improvements. Evidence-based practice, the paradigm used to make those informed decisions, relies on the use of current best evidence from systematic research such as randomized controlled trials. Limitations of the outcomes from randomized controlled trials (RCT), such as “quantity” and “quality” of evidence generated, has lowered healthcare professionals’ confidence in using EBP. An alternate paradigm of Practice-Based Evidence has evolved with the key being evidence drawn from practice settings. Through the use of health information technology, electronic health records (EHR) capture relevant clinical practice “evidence”. A data-driven approach is proposed to capitalize on the benefits of EHR. The issues of data privacy, security and integrity are diminished by an information accountability concept. Data warehouse architecture completes the data-driven approach by integrating health data from multi-source systems, unique within the healthcare environment.

This is an ongoing research investigating the use of health information technologies (HIT) to improve clinical decision-making processes. Effective and timely clinical decision-making can lead to positive improvements in patient’s health outcome...