Home » Research » Medical Knowledge Management » Computerizable Clinical Practice Guidelines Lifecycle
Level of Evidence & Strength of Recommendation
Traditional Clinical Practice Guidelines Lifecycle
Computerized Clinical Practice Guidelines Lifecycle
Computerized Clinical Practice Guidelines Systems Review
SAGE and Guide for “workflow awareness”
1996
Evidence-based Healthcare: How to Make Health Policy and Management Decisions
J.A.Muir Gray, Churchill Livingstone
In the last years, many research groups put efforts in the computerized CPGs field and developed tools for the representation and execution of CPGs [1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12], and recently two comprehensive papers has been published about the comparison of the different formalisms and tools [13, 14]. The computerization of guidelines could lead to several improvements with respect to the traditional textual format: the text disambiguation, the possibility of viewing the guideline at different levels of detail without loosing the entire view, and the possibility of generating patient-tailored suggestions. This could help physicians to better comply with CPGs. However, recent literature shows that these potential benefits are hardly achieved by the CPGs everyday usage [15, 16]. In particular, it has been argued that the CPGs failure to support medical decision making could be due to the poor user's willingness to use them [17]. In turn, poor willingness could derive from a low integration with the existing legacy systems and a low consideration of organizational and human aspects, the so called "socio-technological issues". From a KM point of view, computerized CPGs are models trying to make the knowledge embedded in textual CPGs as explicit as possible. It is in fact a codification that aims to put medical knowledge into a form that makes it accessible to those who need it. Codification literally puts knowledge into a code to make it as organized, explicit, portable and easy to understand as possible. Obviously, whichever method of codification will be used (singly or in combination) within an organization, it will lead to value and in the same time to limitations. Thus, new paradigms and technologies for supporting knowledge codification activities are necessary.
The CPGs, resulting from a complex process based on scientific evidence and experts' consensus, are normally published in unstructured narrative form in textual or electronic (hypertext) documents. The first step for creating a decision support system is their representation into a computational format. Through an authoring tool, these models will be created once, disseminated and adapted locally [18] on the basis of the needs. The enactment systems will implement these models and help the clinicians in their activity, meanwhile keeping track, in a "logs" database, of all the tasks carried out for each individual patient. This controlled loop will help locally tuning the CPG and, at a higher level, suggest modification of the original guideline.
Computerized Clinical Practice Guidelines Systems Review »
[1]
Quaglini S, Dazzi L, Gatti L, Stefanelli M, Fassino C, Tondini C.
Supporting tools for guideline development and dissemination.
Artificial Intelligence in Medicine 1998; 14:119-137
[2] Quaglini S, Stefanelli M, Cavallini A, Micieli G, Fassino C, Mossa C.
Guideline-based Careflow Systems.
Artificial Intelligence in Medicine 2000; 20(1) 5-22
[3] Ciccarese P, Caffi E, Boiocchi L, Quaglini S, Stefanelli
A Guideline Management System.
Medinfo 2004 ,ed Fieschi/Coiera e Yu-Chan Jack Li, IOS Press ,pag. 28 - 32 (2004)
[4] A. A. Boxwala, M. Peleg, S. W. Tu, O. Ogunyemi, Q. Zeng, D. Wang, V. L. Patel, R. A. Greenes, E. H. Shortliffe
GLIF3: A Representation Format for Sharable Computer-Interpretable Clinical Practice Guidelines.
Journal of Biomedical Informatics (JBI), 37 (3): 147-161 2004.
[5] S. W. Tu, M. A. Musen.
The EON Model of Intervention Protocols and Guidelines.
James J. Cimino, Ed., 1996 AMIA Annual Fall Symposium, Washington, D.C., 587-591. Hanley & Belfus, 1996.
[6] Bury J., Fox J., Sutton D.
The PROforma guideline specification language: progress and prospects.
Proceedings of the First European Workshop, Computer-based Support for Clinical Guidelines and Protocols (EWGLP 2000), Leipzig 13-14 Nov. 2000.
[7] Sutton DR, Fox J.
The Syntax and Semantics of the PROforma guideline modelling language.
J Am Med Inform Assoc. 2003 Sep-Oct;10(5):433-43.
[8] Purves IN, Sugden B, Booth N, Sowerby M.
The PRODIGY project - the iterative development of the release one model
Proc AMIA Symp. 1999;:359-63.
[9] Johnson P, Tu S, Jones N.
Achieving reuse of computable guideline systems.
Medinfo. 2001;10(Pt 1):99-103.
[10] Shahar, Y., Miksch, S., and Johnson, P.
The Asgaard project: A task-specific framework for the application and critiquing of time-oriented clinical guidelines.
Artificial Intelligence in Medicine (14): 29-51, 1998.
[11] J. R. Campbell, S. W. Tu, J. G. Mansfield, J. I. Boyer, J. McClay, C. Parker, P. Ram, S. M. Scheitel, K. McDonald.
The SAGE Guideline Model: A Knowledge Representation Framework for Encoding Interoperable Clinical Practice Guidelines.
2003.
[12] P. Ram, D. Berg, S. W. Tu, J. G. Mansfield, Q. Ye, R. Abarbanel.
Executing Clinical Practice Guidelines using the SAGE Execution Engine.
2003.
[13] Peleg M, Tu S, Ciccarese P, Kumar A, Quaglini S, Stefanelli M et al.
Comparing models of decision and action for guideline-based decision support: a case-study approach.
JAMIA 2003; vol. 1 ,n.10, 52-68
[14] P.A. de Clercq, J.A. Blom, H.H. Korsten and A. Hasman.
Approaches for creating computer-interpretable guidelines that facilitate decision support.
Artif Intell Med. 2004; 31(1): 1-27
[15] Barner E. S., Baker S, Funkhouser E. et al.
Do local opinion leaders augment hospital quality improvement efforts? A randomized trial to promote adherence to unstable angina guidelines.
Med Care 2003; 41; 420-431.
[16] Eccles M., McColl E. et al.
Effect of computerized evidence based guidelines on management of asthma and angina in adults in primary care: cluster randomised controlled trial.
BMJ 2002 vol. 325.
[17] Lazarsfeld PF, Merton RK.
Friendship as social process: a substantive and methodological analysis.
In Berger M, et al. (eds.). Freedom and Control in Modern Society. New York: Octagon, 1964.
[18] D.B. Fridsma ,J.H. Gennari, M.A. Musen.
Making generic guidelines site-specific.
Proc. AMIA 1996, 597-601.
