Architectural Approaches for Implementing Clinical Decision Support Systems in Cloud: A Systematic Review

Clinical Decision Support Systems (CDSS) were explicitly introduced in the 90's with the aim of providing knowledge to clinicians in order to influence its decisions and, therefore, improve patients' health care. There are different architectural approaches for implementing CDSS. Some of these approaches are based on cloud computing, which provides on-demand computing resources over internet. The goal of this paper is to determine and discuss key issues and approaches involving architectural designs in implementing a CDSS using cloud computing. To this end, we performed a standard Systematic Literature Review (SLR) of primary studies showing the intervention of cloud computing on CDSS implementations. Twenty-one primary studies were reviewed. We found that CDSS architectural components are similar in most of studies. Cloud-based CDSS are most used in Home Healthcare and Emergency Medical Systems. Alerts/Reminders and Knowledge Service are the most common implementations. Major challenges are around security, performance and compatibility. We concluded on the benefits of implementing a cloud-based CDSS, since it allows cost-efficient, ubiquitous and elastic computing resources. We highlight that some studies show weaknesses regarding the conceptualization of a cloud-based computing approach and lack of a formal methodology in the architectural design process.