Interoperability Mechanisms of Clinical Decision Support Systems: A Systematic Review

The interoperability of Clinical Decision Support (CDS) systems is an important obstacle for their adoption. The lack of appropriate mechanisms to specify the semantics of their interfaces is a common barrier in their implementation. In this systematic review we aim to provide a clear insight into current approaches for the integration and semantic interoperability of CDS systems. Published conference papers, book chapters and journal papers from Pubmed, IEEE Xplore and Science Direct databases were searched from January 2007 until January 2016. Inclusion criteria was based on the approaches to enhance semantic interoperability of CDS systems. We selected 41 papers to include in the systematic review. Five main complementary mechanisms to enable CDS systems interoperability were found. 22% of the studies covered the application of medical logic and guidelines representation formalisms; 63% presented the use of clinical information standards; 32% made use of semantic web technologies such as ontologies; 46% covered the use of standard terminologies; and 32% proposed the use of web services for CDS encapsulation or new techniques for the discovery of systems. Information model standards, terminologies, ontologies, medical logic specification formalisms and web services are the main areas of work for semantic interoperability in CDS. Main barriers in the interoperability of CDS systems are related to the effort of standardization, the variety of terminologies available, vagueness of concepts in clinical guidelines, terminological expressions computation and definitions of reusable models.