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The field of biomedical informatics can be defined as the scientific discipline that deals with biomedical information, data, and knowledge including their storage, retrieval, and optimal use for problem solving and decision making.1 The fields of bioinformatics, imaging informatics, clinical informatics, and public health informatics are all grouped under this larger umbrella.1,2 Most relevant to this chapter, clinical informatics is motivated by applied problems in clinical care encompassing both patient-specific information and knowledge-based information. The electronic medical record is an application based on patient-specific information, whereas MEDLINE, which is provided by the National Library of Medicine, is a key resource for health-related knowledge retrieval.2 A clinical decision support system (CDSS) is a computer program designed to help clinicians make diagnoses or management decisions3 and often relies on both patient-specific and knowledge-based information.2
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The goal of invasive neuromonitoring, or multimodality monitoring, is to provide neurophysiologic decision support at the bedside. Advanced monitoring techniques can provide real-time information regarding the relative health or distress of the brain. This information can be used to set physiologic end points to guide goal-directed therapy and thereby create and maintain an optimal physiologic environment for the comatose injured brain to heal.4 From a critical standpoint, multimodality monitoring as a clinical decision support system is still in its infancy. Patient-specific information from patient monitors and devices are not easy to obtain, manipulate, or visualize, and knowledge-based information is largely dependent on what is known by the clinician looking at the data. That said, the field is now starting to evolve rapidly and the realization of the potential benefits of multimodality monitoring, and CDSSs in general, is only going to increase. This chapter is designed to help you implement neurophysiologic decision support systems in your intensive care unit (ICU).
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Are neurophysiologic decision support systems really needed in the ICU?
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It is true that there is a paucity of CDSSs of any type operating in the ICU,5 and yet it may be the clinical setting in greatest need for such systems. Clinicians may be confronted with more than 200 variables6 during morning rounds, and yet people are not able to judge the degree of relatedness between more than two variables.7 Our ability to collect patient data far exceeds our intellectual capacity to understand it unassisted5 and greatly contributes to conditions of constant information overload that can lead to preventable medical errors.7,8 Implementation of CDSSs to help us understand the clinical meaning of patient data is essential.9,10
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Why are ICU CDSSs not already widely available?
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Generally speaking, there is a lack of clinical informatics infrastructure to support these systems. Adoption of electronic health record (EHR) systems is being promoted by the Department of Health and Human Services through the office of National Coordinator for Health Information Technology ...