Web-based personalised risk assessment and decision support tool
| developed by |
clinical domains |
keywords |
| laboratoire de Santé Publique et Informatique Médicale (SPIM), Université Paris V;
Service CepiDC (Centre d’Epidémiologie
des causes Médicales de Décès - Epidemiological Center on the Medical
Causes of Death) de l’INSERM;
Laboratoire d'Enseignement et de Recherche sur le Traitement de l'Information Médicale (LERTIM),
Université de la Méditerranée Marseille.
|
Cardiovascular risk management, cancer screening, tobacco smoking cessation, alcohol addiction, depression,
genetic epidemiology.
Alcool, Cancer de la prostate, Cancer du colon, Cancer du sein, Col utérin,
Dépression, Diabète, Hypertension artérielle, Lipides,
Ménopause et prévention de l'ostéoporose,
Risque cardio-vasculaire,
Tabac.
|
Internet applications, decision support, knowledge-based systems, risk assessment, risk management, clinical practice guidelines and protocols, point-of-care systems |
| commissioned |
status |
Access |
| November 2003 |
Available free of charge to all registered
health professionals (registration required). |
EsPeR must only be used in consultation with health professionals. |
 Description |
"
EsPeR est un outil d'aide informatisé, pour hiérarchiser les priorités de prévention chez un patient donné, et lui proposer des actions de prévention en accord avec les données scientifiques actuelles. L'outil est destiné au médecin et vise à lui donner, face à sujet consultant, les éléments qui permettent de classer ses risques de santé les plus probables, en prenant en compte :
- la prévalence des maladies dans sa zone géographique de résidence, selon son âge et son sexe
- ses antécédents familiaux,
- ses comportements (tabac, alcool, activité physique, nutrition)
- les caractéristiques cliniques et biologiques de routine, démontrées comme étant susceptibles d'influencer le risque de maladie dans les années à venir.
L'outil permet, pour un sujet consultant donné :
- la saisie de données patient : accès sécurisé par médecin (login et mot de passe) à une liste de dossiers-patient.
- la hiérarchisation des risques de mortalité : une information générale sur les risques de mortalité d'un individu, donnée à partir de l'exploitation des données de mortalité françaises. L'objectif est de donner, pour un individu, un aperçu du contexte épidémiologique de sa région, en calculant pour la population de même âge et même sexe les 10 risques majeurs parmi 15 grandes causes de mortalité évitable.
- le calcul des risques de maladies cardio-vasculaires et de certains cancers et une présentation individualisée des recommandations de l'ANAES pour la prise en charge des différents facteurs de risque cardio-vasculaire et pour le dépistage des cancers (cancer du sein, cancer colorectal, ...) ;
- l'édition (et l'impression) d'une synthèse des recommandations pour le médecin et d'un programme individualisé de prévention destiné au patient.
EsPeR est également un outil documentaire pour comprendre et approfondir les connaissances sur lesquelles doivent reposer les stratégies de prévention. Les modules " Documentation " et la " Bibliothèque " permettent :
- L'accès à une explication des méthodes et du vocabulaire employé dans le logiciel
- Des liens sur différentes sources de connaissances.
" [SPIM].
|
 Description |
EsPeR is a web-based decision support system for screening, risk assessment and prevention. It provides, for a given individual, a personalized assessment of his/her main health risks and offers recommendations for controlling or reducing these risks based on the patient's individual profile and the latest French national evidence-based clinical practice guidelines. EsPeR aims to improve health professionals' and patients' knowledge of health risks on individual, regional and national levels.
EsPeR has four main functions:
- To provide information on the 10 highest risks of avoidable causes of death according to demographic characteristics (age, sex and region of residence)
- To provide an assessment of the specific risks affecting each individual based on published clinical practice guidelines and risk prediction models
- To provide information on cardiovascular risk management, cancer screening, tobacco smoking cessation, alcohol addiction, depression and suicide (based on French national guidelines developed by l'Agence Nationale d'Accréditation et d'Evaluation en Santé (ANAES) (French National Agency for Accreditation and Evaluation in Health) and l'Agence Française de Sécurité Sanitaire et des Produits de Santé (AFSSAPS)).
- To offer a printable summary of advice for physicians and patients of information designed to reduce health risks.
The guideline model used in EsPeR was derived from GLIF 2,
to represent the decision tree as an XML DTD, which is read and executed by a custom-built inference engine.
The development of EsPeR has been supported by CANAM (one of three French social security and health insurance organisations) since 1998.
It continues to be supported (in 2004) by all three social security organisations (CANAM, CNAMTS and MSA).
|
| references |
Colombet I, Aguirre-Junco AR, Zunino S et al.
Electronic implementation of guidelines in the EsPeR system: a knowledge specification method.
Int J Med Inform. 2005 Aug;74(7-8):597-604.
[PubMed]
[]
|
"
Despite initiatives to standardize methods for the development of clinical guidelines, several barriers hinder their integration in daily clinical practice: failure to fulfil quality criteria, poor effectiveness of their dissemination. Computerization of guidelines can favor their dissemination. The initial step of computerization is the knowledge specification from the text of the guideline. We describe the method of knowledge specification, which is used in EsPeR (Personalized Estimate of Risks), a web-based decision support system in preventive medicine, which allows, for a given person, to estimate risks and access recommendations, based on clinical profile. This method is based on a structured and systematic analysis of text allowing detailed specification of a decision tree. We use decision tables to validate the decision algorithm and decision trees to specify this algorithm, along with elementary messages of recommendation. Editing tools are used to facilitate the process of validation and the workflow between expert physicians and computer scientists. Applied to eleven different guidelines, the method allows a quick and valid computerization and integration in the EsPeR system. The method used for computerization could help to define a framework usable at the initial step of guideline development in order to produce guidelines ready for electronic implementation.
"
|
Aguirre-Junco AR, Colombet I, Zunino S et al.
Computerization of guidelines: a knowledge specification method to convert text to detailed decision tree
for electronic implementation.
Medinfo. 2004;11(Pt 1):115-9.
[PubMed]
[]
|
"
The initial step for the computerization of guidelines is the knowledge specification from the prose text of guidelines. We describe a method of knowledge specification based on a structured and systematic analysis of text allowing detailed specification of a decision tree. We use decision tables to validate the decision algorithm and decision trees to specify and represent this algorithm, along with elementary messages of recommendation. Edition tools are also necessary to facilitate the process of validation and workflow between expert physicians who will validate the specified knowledge and computer scientist who will encode the specified knowledge in a guide-line model. Applied to eleven different guidelines issued by an official agency, the method allows a quick and valid computerization and integration in a larger decision support system called EsPeR (Personalized Estimate of Risks). The quality of the text guidelines is however still to be developed further. The method used for computerization could help to define a framework usable at the initial step of guideline development in order to produce guidelines ready for electronic implementation.
"
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Colombet I, Xu Y, Jaulent MC, Desages D, Degoulet P, Chatellier G.
A generic computerized method for estimate of familial risks.
Proc AMIA Symp. 2002;:175-9.
[PubMed]
[]
|
"
Most guidelines developed for cancers screening and for cardiovascular risk management use rules to estimate familial risk. These rules are complex, difficult to memorize, and need to collect a complete pedigree. This paper describes a generic computerized method to estimate familial risks and its implementation in an internet-based application. The program is based on 3 generic models: a model of the family; a model of familial risk; a display model for the pedigree. The model of family allows to represent each member of the family and to construct and display a family tree. The model of familial risk is generic and allows easy update of the program with new diseases or new rules. It was possible to implement guidelines dealing with breast and colorectal cancer and cardiovascular diseases prevention. First evaluation with general practitioners showed that the program was usable. Impact on quality of familial risk estimate should be more documented.
" |
Colombet I, Dart T, Leneveut L, Zunino S, Menard J, Chatellier G.
Combining risks estimations and clinical practice guidelines in a computer decision aid: a pilot study of the EsPeR system.
Stud Health Technol Inform. 2003;95:525-30.
[PubMed]
[]
|
"
Many preventable diseases such as ischemic heart diseases or breast cancer are still not adequately managed in the population. Computerized decision support systems are one of the solutions for improving the quality of prevention strategies. We designed a system called EsPeR (Personalised Estimate of Risks) combining calculation of several risks and computerisation of guidelines (cardio-vascular prevention, screening for breast cancer, colorectal cancer, uterine cervix cancer, and prostate cancer, diagnosis of depression and suicide risk). We present a qualitative evaluation of its ergonomics, its understanding and acceptance by a group of general practitioners. We organised 4 focus groups comprising 6-11 general practitioners. Physicians worked on several structured clinical scenario with help of EsPeR, and 3 senior investigators leaded structured discussion sessions. Initial sessions identified several ergonomics flaws that were easily corrected. Both clinical scenari and discussion sessions identified several problems of insufficient comprehension (expression of risks, definition of familial history of disease), lack of knowledge, and acceptance of recommendation by both the physician. Educational and organisational components (i.e. time constraints) as well as acceptance of evidence-based decision-making should be taken into account before launching computerised decision support system, or testing them in randomised trials.
" |
Colombet I, Dart T, Leneveut L et al.
A computer decision aid for medical prevention: a pilot qualitative study of the Personalized Estimate of Risks (EsPeR) system.
BMC Med Inform Decis Mak. 2003 Nov 27;3(1):13.
[PubMed]
[PubMed Central]
|
"
Background:
Many preventable diseases such as ischemic heart diseases and breast cancer prevail at a large scale in the general population. Computerized decision support systems are one of the solutions for improving the quality of prevention strategies.
Methods:
The system called EsPeR (Personalised Estimate of Risks) combines calculation of several risks with computerisation of guidelines (cardiovascular prevention, screening for breast cancer, colorectal cancer, uterine cervix cancer, and prostate cancer, diagnosis of depression and suicide risk). We present a qualitative evaluation of its ergonomics, as well as it's understanding and acceptance by a group of general practitioners. We organised four focus groups each including 6–11 general practitioners. Physicians worked on several structured clinical scenari os with the help of EsPeR, and three senior investigators leaded structured discussion sessions.
Results:
The initial sessions identified several ergonomic flaws of the system that were easily corrected. Both clinical scenarios and discussion sessions identified several problems related to the insufficient comprehension (expression of risks, definition of familial history of disease), and difficulty for the physicians to accept some of the recommendations.
Conclusion:
Educational, socio-professional and organisational components (i.e. time constraints for training and use of the EsPeR system during consultation) as well as acceptance of evidence-based decision-making should be taken into account before launching computerised decision support systems, or their application in randomised trials.
" |
Dart T, Xu Y, Chatellier G, Degoulet P. Computerization of guidelines: towards a "guideline markup language".
Medinfo. 2001;10(Pt 1):186-90.
[PubMed]
[]
|
"
Medical decision making is one of the most difficult daily tasks for physicians. Guidelines have been designed to reduce variance between physicians in daily practice, to improve patient outcomes and to control costs. In fact, few physicians use guidelines in daily practice. A way to ease the use of guidelines is to implement computerised guidelines (computer reminders). We present in this paper a method of computerising guidelines. Our objectives were: 1) to propose a generic model that can be instantiated for any specific guidelines; 2) to use eXtensible Markup Language (XML) as a guideline representation language to instantiate the generic model for a specific guideline.Our model is an object representation of a clinical algorithm, it has been validated by running two different guidelines issued by a French official Agency. In spite of some limitations, we found that this model is expressive enough to represent complex guidelines devoted to diabetes and hypertension management. We conclude that XML can be used as a description format to structure guidelines and as an interface between paper-based guidelines and computer applications.
" |
|
| contact |
links |
Isabelle Colombet
Laboratoire de Santé Publique et Informatique Médicale
15, rue de l’école de Médecine
75006 PARIS
France
E: isabelle.colombet@spim.jussieu.fr
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Entry on OpenClinical: 1 September 2004
Last main update: 1 September 2004, (24 January 2006)
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EsPeR