A framework and tools for authoring, editing, documenting, sharing, searching, navigating, and executing computer-based clinical guidelines.

With the spread of managed care and integrated delivery networks, an increased emphasis has been placed on the cost-effectiveness of clinical practices. The need has been recognized to use guidelines to support education, and to integrate them into clinical practice. A specification for guideline representation that would facilitate computer-based clinical guideline sharing has been developed by the InterMed Collaboratory. Called GLIF (GuideLine Interchange Format), this specification and its proposed extensions have been the basis for our implementation of a framework and suite of integrated software tools for guideline authoring and editing, packaging in XML, Internet distribution, navigation, eligibility determination, and automatic execution.

Architecture for a multipurpose guideline execution engine.

Integration of guideline knowledge into the clinical workflow is essential, for improving adherence to guidelines. Guidelines in structured formats can be utilized by computer programs to provide decision support in clinical information systems, as well as to facilitate workflow. We have designed an architecture for a flexible guideline execution engine that can be utilized in clinical decision support applications. The engine may be utilized for other applications such as referral management, medical education, and conducting clinical trials. The engine executes guidelines that are defined in an extension of the Guideline Interchange Format (GLIF). GLIF was extended to support representation of constructs that are essential to the execution of the guideline. A prototype of the engine was implemented based on this architecture. The engine is being utilized in two clinical applications that draw on guidelines for decision support. The engine was also used for developing an educational application aimed at testing knowledge of guideline recommendations.

Radiology systems architecture.

This article focuses on the software requirements for enterprise integration in radiology. The needs of a future radiology systems architecture are examined, both at a concrete functional level and at an abstract system-properties level. A component-based approach to software development is described and is validated in the context of each of the abstract system requirements for future radiology computing environments.

Constructing Workstation Applications: Component Integration Strategies for a Changing Health-Care System.

A health-care workstation is the means by which a professional interacts with the information artifacts of health care. However, a major transformation is taking place in the software architecture of health-care systems that alters significantly the role of the workstation. Health-care systems are becoming more complex in response to the need to support "extended enterprises" across regions, and provide both horizontal and vertical integration capabilities. Component-based software methodologies are being introduced that match well the needs of these large systems and the component services they must integrate. In the component-based framework, a workstation functions less as a "portal" for information transactions carried out on distant host computers, and more as the "orchestrator" for tasks involved in assembling, organizing, presenting, and manipulating information. Applications residing on workstations access distributed software components that carry out encapsulated functions for the application. Component-integration methodologies include both formal and ad hoc approaches; the principal emerging technologies are the World Wide Web (WWW), CORBA, Java, OLE, and OpenDoc. An emerging strategy appears to be that of developing application integration environments that encompass and support all of these integration methodologies. Component-based approaches also facilitate standardization at the message level, as messages to classes of components can serve to focus such standardization.

Collaborative health care information system development through sharable infrastructure, services, and paradigms.

The Decision Systems Group has focused for several years on software architectures and software engineering approaches to support collaborative development for health care information systems. The goal is to be able to more readily develop complex applications that require integration of a variety of information resources. Our efforts are aimed at four primary capabilities: (1) a software environment, Arachne, for developing applications by incorporation of components created by disparate developers, developing component classes, for providing cross-platform graphical user interface support with remote rendering, and incorporating evolving software engineering standards; (2) a library of domain-specific components for medical applications; (3) a user interaction paradigm that provides a framework for applications that integrate both clinical data and other information resources for education and decision support; and (4) improved understanding of the collaborative process per se and the development of methodologies to support it.

The DeSyGNER data access element: a readily reusable component for the construction of data-compatible multimedia programs.

Dynamic assembly of applications from diverse and possibly disparate collections of information components is a key element for powerful information management environments. Traditional methods of application development hinder flexible integration of information components because they treat computer programs as single, isolated units of functionality where inter-application connections and sharing of intra-application information components are achieved only by special cooperation between program authors. Although many programmers strive to develop re-usable program code, it is rare that independently developed components can be readily combined into new applications. One of the major reasons for this is that there is no overall agreement as to the types of segments written, how the segments communicate, or how their data is stored. We have created a multimedia applications development architecture called DeSyGNER (the Decision Systems Group Nucleus of Extensible Resources) that provides a type-independent definition of the fundamental information-bearing unit for the construction of data-compatible applications. By incorporating a common high-level architecture and an intrinsically modular object-oriented design, DeSyGNER applications process information in smaller, isolatable, and more mobile and reusable units than do monolithic computer programs.

Application development in the DeSyGNER environment: dynamic assembly of independent information resources via direct manipulation authoring.

Dynamic assembly of applications from diverse and possibly disparate collections of information components is a key element for powerful information management environments. Traditional methods of application development hinder flexible integration of information components because they treat computer programs as single units of functionality; inter-application connections and sharing of intra-application information components are achieved only by special cooperation between program authors. We have created a multimedia applications development architecture called DeSyGNER (the Decision Systems Group Nucleus of Extensible Resources) that provides a generalized framework for the inter-connection of independently developed units into applications. By focusing on composition methods or paradigms for constructing applications from modular, reusable units, DeSyGNER fosters sharing and cooperation in application development.