Background
Rare Diseases (RD), which are defined as diseases affecting not more than 5 out of 10,000 people, are often severe, chronic, degenerative and life-threating. A main problem is the delay in diagnosis of RD. Clinical Decision Support Systems (CDSS) for RD are software-systems to support physicians in the diagnosis of patients with RD. It would therefore be useful to get a comprehensive overview of which CDSS are available and can be used under what conditions. In this work we provide a review of current CDSS in RD and which functionality and data are used by the CDSS.
Methods
We searched Pubmed and Cochrane for CDSS in RD published between December 1, 2008 and December 16, 2018. Only English articles, original peer reviewed journals and conference paper describing a clinical prototype or a routine use of CDSS where included. A total of 2076 articles were found and following a screening step 16 articles (describing 13 different CDSS) were considered as relevant for the final analysis. We then described and compared the CDSS using the defined categories “functionality”, “development status”, “type of clinical data” and “system availability”.
Results
Three types of CDSS for RD were identified: “Machine Learning and Information retrieval”, “Web Search”, and “Phenotypic and genetic matching”. 8 of the 13 reviewed CDSS are publicly available and for use by physicians. The other remaining CDSS are clinical prototypes which have been applied in clinical studies but are not accessible to others. Only one clinical prototype online.
The approaches of the CDSS differ depending on what type of clinical data is used. “Machine Learning and information retrieval” can show recommendations for a diagnosis, while Web “search CDSS” will retrieve articles from literature databases (e.g. case reports), which may provide hints for a possible Diagnosis. CDSS in “Phenotypic and genetic matching” can identify similar patients based on genetic or phenotypic data.
Conclusions
Different CDSS for different purposes have been established and physicians have to decide which CDSS is more accurate for a particular patient case. It remains to be seen which of the CDSS will be used and maintained in the future.