Health Evaluation through Logical Processing (help)

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  1 History
  
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  2 System Architecture
  
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  3 Clinical Decision Support System
  
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    3.1 Clinical Decision Support System features
    
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  4 Present Status
  
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  5 Evaluation of HELP System
  
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    5.1 User Acceptance
    
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    5.2 Infectious Diseases
    
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    5.3 Management of Adverse Drug Reactions
    
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  6 References
  

HELP was designed by Gardner, Pryor, and Warner [Gardner RM 1999]. The original system was developed at the LDS Hospital in Salt Lake City, Utah, and has been active since 1967. The parent organization is now known at Intermountain Health Care (IHC). This system was designed with the primary purpose of understanding how circulation is controlled. It was used in the cardiac cath lab, and then extended into the Operating Room (OR) and Intensive Care Unit (ICU). Eventually becoming a hospital wide system, and then used at most of the 20 system hospitals.

HELP was developed at the University of Utah, and is enhanced with HCOM, a compiler that allowed Bayesian decision support modules to be developed.

The system originally contained two limitations: physicians had read only access (they were able to review data, but not enter data into the system); and it was not possible to exchange records between different facilities. That changed with the introduction of the Longitudinal patient Data Repository (LDR) starting in the late 1990s.

Advancements in information systems and medical technology present the need for an updated system to replace HELP. HELP2 uses modern software tools and database standards. Features of HELP2 include [6]:

1. 
   Longitudinal medical record covering all inpatient and outpatient health care interactions.
   
2. 
   Vendor-supplied departmental subsystems integrated using HL7-based interfaces.
   
3. 
   Tools to continuously evaluate the effectiveness of decision support interventions.
   
4. 
   Well-supported data mining for new knowledge.
   
5. 
   A network tying together IHC’s facilities across the State of Utah.
   

The original HELP system was made up of the following components [5]:

1. 
   An integrated clinical database
   
2. 
   A frame-based clinical decision support systems
   
3. 
   Programs to support both clinical and administrative functions
   
4. 
   Software tools to support and expand the system
   

The clinical decision supportsystem within HELP has several different functionalities [5]:

1. 
   Alerting systems - These processes function continuously, monitoring clinical data as it is stored in the patient’s electronic record. Ex. monitoring lab results
   
2. 
   Critiquing systems - These processes begin when an order is entered into the information system. HELP points out disparities between the order and internally defined proper care or proposes an alternative approach. Ex. ensuring compliance and proper use of blood products
   
3. 
   Suggesting systems - Clinicians call up a screen, enter requested data, and wait for suggestions. Ex. protocol systems to suggest care