Approaches to Implementing Clinical Decision Support in Commercial Hospital Information Systems using JAVA/CORBA/XML

Introduction. It is widely accepted that computer-based decision support has beneficial impacts in many ways to healthcare providers and patients in order to improve clinical outcomes and cost-effectiveness. Direct integration of knowledge-based functions (KBF) in hospital information systems (HIS) has proven to be more successful than standa-lone systems.' Thus the aim of this study was to exemplarily embed an existing, proven standalone scoring system for acute abdominal pain into two different commercial hospital information systems in three university hospitals. This decision support has to be platform-independent and easily adaptable to different hospital settings and hospital information systems, using distributed, component-based and scalable information sources. Methods. After an initial survey among physicians (n=102), which showed that most of them preferred having decision aids available within a hospital information system2, we performed a workflow-based process analysis3 of the surgical outpatient ward. Subsequently the software was designed according to the following major comerstones (see figure 1): (D) The HIS invokes a knowledge based system manager (KBM) out of the electronic patient record with a HIS-specific invoking mechanism. (0) The KBM retrieves data from the HIS database (HIS DB), using a HIS-specific data access compo