Prototyping a decision support system in the clinical environment: assessment of patients with osteoporosis OSTEODSS

This paper describes a prototype of a decision support system developed to assess patients with osteoporosis. The system was embedded into the clinical workflow environment. This system is being used in two clinics and one hospital center in Canada. Osteoporosis is a disorder with major physical and economical implications. Assessing and properly managing patients with osteoporosis is complex and requires high level of expertise. Expertise alone does not totally address the problem as it involves the attitudes and behavioral states of the general practitioner, the patient and the specialist. The system's architecture, subcomponents and integrated workflow are described. The system was developed based on the experiences of a specialist with 50 patients. As of the end of 2003, the system was used for 45 patients. The reports generated were shown to general practitioners who were not able to distinguish them from an actual specialist report. In this paper we present one case and demonstrate the main differences between the report generated by the system and a report produced by the specialist. Experiences in using the system as it is integrated into the clinical workflow are discussed. Valuable insights into the integration and use of web-based decision support systems are highlighted.