This article outlined the background and the concept of health decision support system (HDSS), discussed its application status in medical service, hospital management, public health management and other fields in the following four developed countries: United States, UK, Canada and Australia. It also introduced the main functions of MYCIN, CPOE, DHCP, Panorama etc., and summarized the above four countries’ successful experiences, including, actively promoting the application of decision support technology in health field through closely combining with the practical needs, valuing evidenced-based resources development and repository research, making scientific health policy to guide the orderly development of decision support systems, and strengthening the construction of E-health infrastructure and core systems, in hopes of providing reference for the development of health decision support system in China.
Objective To observe the effectiveness of skin graft combined with thorax wire fastening for repairing postoperative coloboma after resection of chest back giant nevus. Methods Between June 2007 and October 2010, 17 cases of chest back giant nevus were treated. There were 7 males and 10 females, aged from 3 years and 6 months to 15 years(mean, 8 years). The size of giant nevus was 20 cm × 12 cm to 60 cm × 50 cm. Two cases of them were ever treated by laser, while the others were never treated. The check before operation showed ulcer of the skin and effusion in 2 cases, hard skin in 3 cases, hair growth in 7 cases, and normal in 5 cases. Five cases had serious itch. After giant nevus was cut off, thorax wire was fastened to reduce the wound area, and then the intermediate spl it thickness skin graft of thigh was used to repair the wound. Comprehensive anti-scar treatment was given postoperatively. Results The wound size was (2 110.74 ± 725.69) cm2 after resection of giant nevus, and was (1 624.94 ± 560.57) cm2 after thorax wire fastening, showing significant difference (t=9.006, P=0.001). All the grafting skin survived; the incision and wound at donor site healed by first intention. The patients were followed up 6 months to 2 years (mean, 13 months). No scar prol iferation or contracture occurred. The skin color and elasticity were similar to the normal skin; the nipple, navel, and other local apparatus were not shifted after operation. Conclusion It can reduce donor site of skin and postoperative scar, and achieve satisfactory appearance to cover the wound by skin graft combined with thorax wire fastening after chest back giant nevus was cut off .
The development and application of health decision support system (HDSS) in clinical service and health management is efficient in controlling health expenditure rising from overlapped examinations, and in reducing medical errors rising from insufficient decision-making support tools. Typical HDSS in America includes CPOE, MYCIN, QMR, NEDSS etc., which are mainly used in disease diagnosis and treatment, public health emergency management, hospital management, and health insurance management. The successful experiences accumulated in the development of the US health decision support system are worth referring to, such as, integration of management system, decision-makers and ICT, meeting the urgent needs of clinical service and health management, effective E-health construction, and rational development pathway from clinical decision support system to health management decision support system.
In combination with the national health informatization construction in UK during the past ten years, this article introduced the resource construction of decision making knowledge library like British Electronic Medicine Library Clinical Pathway Database and NHS Evidence, as well as the function and application of clinical decision support system (CDSS) like PRODIGY, medical knowledge map and so on, discussed the development characteristics and construction experiences of British health decision support system (HDSS). And aiming directly at Chinese specific circumstances, this article offered some suggestions on promoting China HDSS development, for instance, dynamically integrating CDSS with patients’ diagnosis and treatment procedure through the electronic medical record system, strengthening the resources construction of knowledge library, establishing localized clinical pathway, and so on.
In order to understand the latest progress of health decision support system (HDSS) construction, grasp the law of HDSS development and adopt the international advanced experience, this paper took Australia for example, presented a comparative analysis on the construction practices, including the contents, features and system functions of national construction guidelines for HDSS in different periods, and showed the integral development level of Australia HDSS was still in the exploratory stage, and its construction goal, function orientation and construction mechanism got improved gradually with the deep development of public health information. Additionally, to assure the accuracy and safety of HDSS function, Australia has been laying stress on the standard specification construction and system function authentication.
The health decision support system in Canada is embodied in Electronic Health Record Solutions, which includes Public Health Surveillance System, Drug Information Systems, Laboratory Information Systems, etc. By virtue of business intelligence and other advanced information techology, the system can realize the function of statistical analysis, data mining, prediction, and transform information into predicting and guiding knowledge, thus support health decision-making in terms of health surveillance, resources allocation and quality control. The success lie in b support from the federal government, efficient responsible organization Infoway as well as comprehensive and strategic design, which can be served as good enlightenment for HDSS construction of China.