Integration of Knowledge Resources into Applications to Enable CDS. Architectural Considerations.

This chapter examines in detail the bridge between the creation and delivery of CDS content - in other words, how knowledge resources can be integrated with clinical information systems (CISs) to enable CDS. While such integration can be relatively straightforward for a single instance - that is, the integration of a specific knowledge resource in a specific clinical information system - the challenge lies in the fact that both knowledge resources and clinical information systems are quite diverse. Consequently, there is no single knowledge integration architecture that can address all circumstances. However, there are several architectural patterns for knowledge integration that can, taken together, enable the effective integration of knowledge resources into applications. The primary purpose of this chapter, then, is to outline the main CDS knowledge integration architectures that are available and to detail the pros and cons of each approach. The appropriateness of a given architecture for a particular organization depends on a variety of factors, including the existing clinical information system infrastructure and the type of CDS capability involved (e.g. real-time vs. non-real-time applications. These various approaches are outlined here, with special attention being placed on knowledge integration architectures aligned with broad trends in the IT landscape, such as service-oriented architectures, cloud-based computing, and app-based software ecosystems. The chapter also discusses how CDS architectures must align with larger changes in the health care industry as a whole, as shifting health care reimbursement models are requiring continuity of care across multiple organizations and health IT systems centered around patients and populations rather than care episodes at individual care settings.