The complexity of medical knowledge has been steadily increasing, the cost of Healthcare services has surged over the years, and growing demands exists for assessing and improving the quality of the Healthcare services. Knowledge based decision support might provide considerable help in solving many of these problems. This report addresses the perspectives of knowledge based decision support applications within the health sector in the next five to ten years, from the complementary perspectives of users, industry and researchers.
The report identifies potential users of decision support in Healthcare, which include not only doctors, but also nurses, Healthcare administrators, as well as patients. It then addresses their requirements and expectations with respect to knowledge based decision support, and discusses the need to integrate such systems and techniques with the Healthcare environment and their routine practices. Some topics are discussed in more depth, namely the change in emphasis from diagnostic support into more general patient management support, the emergence of clinical guidelines developed for this purpose as well as the need to support their development and management, the integration with medical data sources (eg. electronic patient records) and knowledge sources (eg. literature and patient databases), and the need for adequate interfaces with the users and with other, local or remote, information systems.
From the industry perspective, the report discusses the value that knowledge based decision support systems may have for the users, seen as purchasers of these systems. It identifies the industrial sectors whose expertise should be combined to enable the development of commercial knowledge based systems, namely Healthcare information systems suppliers, medical equipment industries, scientific and education publishers, value-added network operators, and pharmaceutical companies. It identifies opportunities for these industries to cooperate in the development of more innovative knowledge based products to extend their traditional product lines. It finally addresses some aspects of engineering of knowledge based applications in Healthcare, to facilitate integration in current products, areas needing research for future products development and competing technologies that must be taken into account.
The report suggests that knowledge based systems research should focus in the problems of integration with the Healthcare environment and discusses priorities for research in the next decade. These include: efforts towards the standardisation of terminologies and ontologies and translation between existing standards; refocussing reasoning methods from pure diagnosis into broader planning, incorporating diagnosis, treatment and monitoring; support to the management and development of patient management guidelines; coordination of these research efforts with the development of structured patient records; research into advanced architectures that allow sharing and reuse of medical knowledge, to ease the problems of knowledge acquisition and validation; integration of knowledge based techniques with telematics and multimedia technology to provide adequate user interfaces to these patient records (with a view on their management) and other Healthcare services; and finally the need to develop metrics and methodologies to assess the value and impact of knowledge based decision support systems.
The main conclusions of these complementary perspectives are summarised in the final chapter which ends with a number of recommendations regarding the planning of future research and development of knowledge based systems and techniques in the Health sector for the next decade.