A scoping review of knowledge authoring tools used for developing computerized clinical decision support systems

Clinical Knowledge Authoring Tools (CKATs) are integral to the computerized Clinical Decision Support (CDS) development life cycle. CKATs enable authors to generate accurate, complete, and reliable digital knowledge artifacts in a relatively efficient and affordable manner. This scoping review aims to compare knowledge authoring tools and derive the common features of CKATs.

We performed a keyword-based literature search, followed by a snowball search, to identify peer-reviewed publications describing the development or use of CKATs. We used PubMed and Embase search engines to perform the initial search (n = 1579). After removing duplicate articles, nonrelevant manuscripts, and not peer-reviewed publication, we identified 47 eligible studies describing 33 unique CKATs. The reviewed CKATs were further assessed, and salient characteristics were extracted and grouped as common CKAT features.

Among the identified CKATs, 55% use an open source platform, 70% provide an application programming interface for CDS system integration, and 79% provide features to validate/test the knowledge. The majority of the reviewed CKATs describe the flow of information, offer a graphical user interface for knowledge authors, and provide intellisense coding features (94%, 97%, and 97%, respectively). The composed list of criteria for CKAT included topics such as simulating the clinical setting, validating the knowledge, standardized clinical models and vocabulary, and domain independence. None of the reviewed CKATs met all common criteria.

Our scoping review highlights the key specifications for a CKAT. The CKAT specification proposed in this review can guide CDS authors in developing more targeted CKATs.