The BACIS program is an example of an e-health decision support system, and therefore a chapter focusing on the topic of decision support systems is needed as part of the background and context to the BACIS program study. The chapter begins with a discussion of the design of decision support systems. In this discussion, the software development methodologies used in their development is explained. Then various architectures for their design are considered. This is followed by a section on implementation of decision support systems in developing country contexts. The chapter closes with a discussion of the Clinical Decision Support (CDS) roadmap of the International Medical Informatics Association.
TopDesign Of Decision Support Systems
The classical waterfall model of systems analysis and development by Royce (1970) has the following steps, requirements specification, technical design, construction, integration, testing and debugging, installation, and maintenance. The structured systems analysis and design model by Yourdon and Constantine (1979), also considered one of the classical approaches, has the following phases, feasibility study, investigation of current environment, business systems options, requirements specification, logical design, and physical design. From these two classical models of systems analysis and design it can be seen that in general there are early phases in systems analysis and design which are focused on requirements analysis and feasibility of the system, as well as later phases that are focused on technical design and implementation of the system. For convenience these two phases have been called requirements analysis, and design, respectively. A third phase, based on health systems research, is evaluating the impact of the system on the health system. This third phase has been called evaluation for convenience. Therefore, in the book the main headings in the model adopted for development of a computerised decision support are, (1) requirements analysis, (2) design, and (3) evaluation.
Requirements Analysis
Requirements analysis considers issues relating to the medical knowledge in the guidelines rather than the technical specification of the system (Shaneyfelt, Mayo-Smith, & Rothwangl 1999). The issues considered in this stage have a direct bearing on whether the system will be successful or not. For example, in order for the system to be successful it has to be based on guidelines which use locally available resources. No matter how technically sophisticated a system may be, it will not succeed if it is based on guidelines that cannot be implemented using locally available resources.