Computerised Decision Support for Women's Health Informatics

Computerised Decision Support for Women's Health Informatics

David Parry (Auckland University of Technology, New Zealand)
Copyright: © 2009 |Pages: 13
DOI: 10.4018/978-1-60566-078-3.ch015
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Abstract

Decision analysis techniques attempt to utilize mathematical data about outcomes and preferences to help people make optimal decisions. The increasing uses of computerized records and powerful computers have made these techniques much more accessible and usable. The partnership between women and clinicians can be enhanced by sharing information, knowledge, and the decision making process in this way. Other techniques for assisting with decision making, such as learning from data via neural networks or other machine learning approaches may offer increased value. Rules learned from such approaches may allow the development of expert systems that actually take over some of the decision making role, although such systems are not yet in widespread use.
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Introduction

Decision analysis involves formally identifying the important aspects of making decisions in terms of the required information, the process followed, and the outcomes expected. Of course, people make decisions all the time without going through this process, so decision analysis is often reserved for situations where the decisions are particularly difficult because there is no good precedent or the decision maker is uncertain, the consequences of making the wrong decision are serious or because the decision making process needs to be particularly explicit and verifiable. As with all informatics activities, computer support is helpful, but not a complete replacement for clinical judgement, or a remedy for poor knowledge of the area.

Computational intelligence involves the use of computers to make decisions themselves, in conjunction with humans, or independently.

Formalising decision making processes allows for a reflection on the decision-making process, and the sharing of this process with others such as colleagues, patients or researchers. The audit of behaviour is linked to the use of evidence–based practice (Rosenberg & Donald, 1995). As part of evidence based practice, clinicians are seen to need to justify their actions in the light of scientific research. Briefly, evidence based practice requires the following stages:

  • Identification of a clinical problem

  • A systematic search for evidence

  • Assessment of the evidence in a structured way

  • Synthesis of the evidence

  • Decision on what is “best practice”

The best practice thus identified becomes the second part of the audit cycle (Figure 1). Decision analysis involves the incorporation of data from good sources of evidence, such as clinical trials in order to identify best practice. This best practice may involve a quite complex process of decision making that depends on many factors, and it may be that decisions need to be segmented in terms of whether they apply to individual cases, groups of patients or whole populations.

Figure 1.

The audit cycle

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Clinical Decision Making

Decision analysis is intended to both model and improve decision-making. The techniques used have a number of similarities but the importance of different aspects of the decision changes with the size of the group being affected. In general, as the groups affected get larger, the distribution of values for parameters are easier to predict, while as groups get smaller then the variation between individuals becomes more important. Dowie made an important point in a 1996 paper (Dowie, 1996) that the decision making process needs to incorporate evidence, cost effectiveness and preferences of the people involved. The use of evidence of clinical benefit, although it is necessary for the choice of action, is not always sufficient to make the decision obvious.

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Editorial Advisory Board
Table of Contents
Foreword
Neil Pattison
Preface
Emma Parry, David Parry
Acknowledgment
Emma Parry, David Parry
Chapter 1
Peter Stone
Improving women’s health is a vital task for the world. The consequences of obstetric and gynecological disease are serious both for the women... Sample PDF
An Introduction to Women's Health and Informatics
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Chapter 2
Premila Fade
Principlism (derived from common sense morality) is the most common theory used within the healthcare sphere. The elements of this theory are... Sample PDF
Women's Health Informatics: The Ethical and Legal Issues
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Chapter 3
David Parry
Recording information about symptoms, observations, actions, and outcomes is a key task of health informatics. Standardization of records is vital... Sample PDF
Coding and Messaging Systems for Women's Health Informatics
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Chapter 4
Gareth Parry
Women’s health in primary care is a large part of the generalist’s practice. Information technology (IT) is now an integral part of the generalist’s... Sample PDF
Women's Health Informatics in the Primary Care Setting
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Chapter 5
Emma Parry
The seamless electronic health record is often hailed as the holy grail of health informatics. What is an electronic health record? This question is... Sample PDF
The Electronic Health Record to Support Women's Health
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Chapter 6
Graham Parry
Information technology and communication systems have made imaging in women’s health easier at many levels. There are now many commercial systems on... Sample PDF
Imaging and Communication Systems in Obstetrics and Gynecology
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Chapter 7
Emma Parry
Pregnancy is unique in medicine in providing a discrete event with a fixed end. It is well suited to data collection and statistical assessment.... Sample PDF
Statistical Measures in Maternity Care
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Chapter 8
Kiran Massey, Tara Morris, Robert M. Liston
Our ultimate goal as obstetric and neonatal care providers is to optimize care for mothers and their babies. As such, we need to identify practices... Sample PDF
Building Knowledge in Maternal and Infant Care
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Chapter 9
Malcolm Battin, David Knight, Carl Kuschel
Neonatal care is an extremely data-intensive activity. Physiological monitoring equipment is used extensively along with web-based information tools... Sample PDF
Informatics Applications in Neonatology
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Chapter 10
Jenny Westgate
During pregnancy the fetus requires an adequate supply of oxygen and clearance of carbon dioxide which is a waste product of metabolism. In fetal... Sample PDF
Computerizing the Cardiotocogram (CTG)
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Chapter 11
Liron Pantanowitz
Automation and emerging information technologies are being adopted by cytology laboratories around the world to augment Pap test screening and... Sample PDF
Computer Assisted Cervical Cytology
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Chapter 12
Laurie Elit, Susan Bondy, Michael Fung-Kee-Fung, Prafull Ghatage, Tien Le, Barry Rosen, Bohdan Sadovy
Ovarian cancer affects 2,400 women annually in Canada with a case fatality ratio of 0.70. There are several practice guidelines that indicate women... Sample PDF
Informatics and Ovarian Cancer Care
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Chapter 13
Jamila Abuidhail
Information and communication technologies include computers, telecommunication, digital networks, and television. Using informatics in healthcare... Sample PDF
Women's Health and Health Informatics: Perinatal Care Health Education
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Chapter 14
Shona Kirtley
In an age where health professionals lead very busy working lives, electronic information sources provide ease of access to vast amounts of health... Sample PDF
Electronic Information Sources for Women's Health Knowledge for Professionals
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Chapter 15
David Parry
Decision analysis techniques attempt to utilize mathematical data about outcomes and preferences to help people make optimal decisions. The... Sample PDF
Computerised Decision Support for Women's Health Informatics
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Chapter 16
Michelle Brear
The influence of organizational factors on the success of informatics interventions in healthcare has been clearly demonstrated. This health... Sample PDF
Organizational Factors: Their Role in Health Informatics Implementation
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Chapter 17
Josipa Kern
When things go well then often it is because they conform to standards (ISO, 2005). According to the Oxford Dictionary of Modern English, there is a... Sample PDF
Standardization in Health and Medical Informatics
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Chapter 18
Elske Ammenwerth, Stefan Gräber, Thomas Bürkle, Carola Iller
This chapter summarizes the problems and challenges which occur when health information systems are evaluated. The main problem areas presented are... Sample PDF
Evaluation of Health Information Systems: Challenges and Approaches
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Chapter 19
Pirkko Nykänen
eHealth refers to use of information and communication technologies to improve or enable health and healthcare. eHealth broadens the scope of health... Sample PDF
eHealth Systems, Their Use and Visions for the Future
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Chapter 20
Nilmini Wickramasinghe, Santosh Misra, Arnold Jenkins, Douglas R. Vogel
Superior access, quality and value of healthcare services has become a national priority for healthcare to combat the exponentially increasing costs... Sample PDF
The Competitive Forces Facing E-Health
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About the Contributors