Decision support for drug prescription integrated with computer-based patient records in primary care

A conceptual model of an information system that integrates a controlled vocabulary, a patient database, and a knowledge base is described. Methods, design and components for the implementation of the system are discussed. It is argued that the key issue for the successful introduction of computer-based decision support in primary care today is integration with a computer-based patient record. Also important is that the knowledge acquisition process is based on the general practitioner's real needs. This has been achieved by, first, providing general practitioners with real patient data from a series of retrospective database studies; and second, letting a panel of general practitioners select, discuss and decide which computer reminders to implement. A hybrid representation scheme was chosen for the knowledge base. The combination of a standard procedural representation (the so-called Arden syntax) for the reminder knowledge with a semantic net representation for the medical factual knowledge facilitates knowledge sharing with other systems and knowledge reuse within the system.