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1.
J Am Med Inform Assoc ; 14(5): 589-98, 2007.
Article in English | MEDLINE | ID: mdl-17600098

ABSTRACT

The SAGE (Standards-Based Active Guideline Environment) project was formed to create a methodology and infrastructure required to demonstrate integration of decision-support technology for guideline-based care in commercial clinical information systems. This paper describes the development and innovative features of the SAGE Guideline Model and reports our experience encoding four guidelines. Innovations include methods for integrating guideline-based decision support with clinical workflow and employment of enterprise order sets. Using SAGE, a clinician informatician can encode computable guideline content as recommendation sets using only standard terminologies and standards-based patient information models. The SAGE Model supports encoding large portions of guideline knowledge as re-usable declarative evidence statements and supports querying external knowledge sources.


Subject(s)
Decision Support Systems, Clinical , Practice Guidelines as Topic/standards , Hospital Information Systems , Humans , Knowledge Bases , Medical Order Entry Systems , Models, Theoretical , Software , Systems Integration , User-Computer Interface , Vocabulary, Controlled
2.
AMIA Annu Symp Proc ; : 784-8, 2006.
Article in English | MEDLINE | ID: mdl-17238448

ABSTRACT

Developing computer-interpretable clinical practice guidelines (CPGs) to provide decision support for guideline-based care is an extremely labor-intensive task. In the EON/ATHENA and SAGE projects, we formulated substantial portions of CPGs as computable statements that express declarative relationships between patient conditions and possible interventions. We developed query and expression languages that allow a decision-support system (DSS) to evaluate these statements in specific patient situations. A DSS can use these guideline statements in multiple ways, including: (1) as inputs for determining preferred alternatives in decision-making, and (2) as a way to provide targeted commentaries in the clinical information system. The use of these declarative statements significantly reduces the modeling expertise and effort required to create and maintain computer-interpretable knowledge bases for decision-support purpose. We discuss possible implications for sharing of such knowledge bases.


Subject(s)
Decision Support Systems, Clinical , Drug Therapy, Computer-Assisted , Hypertension/drug therapy , Knowledge Bases , Practice Guidelines as Topic , Humans , Software , User-Computer Interface
3.
Stud Health Technol Inform ; 107(Pt 1): 174-8, 2004.
Article in English | MEDLINE | ID: mdl-15360798

ABSTRACT

The success of clinical decision-support systems requires that they are seamlessly integrated into clinical workflow. In the SAGE project, which aims to create the technological infra-structure for implementing computable clinical practice guide-lines in enterprise settings, we created a deployment-driven methodology for developing guideline knowledge bases. It involves (1) identification of usage scenarios of guideline-based care in clinical workflow, (2) distillation and disambiguation of guideline knowledge relevant to these usage scenarios, (3) formalization of data elements and vocabulary used in the guideline, and (4) encoding of usage scenarios and guideline knowledge using an executable guideline model. This methodology makes explicit the points in the care process where guideline-based decision aids are appropriate and the roles of clinicians for whom the guideline-based assistance is intended. We have evaluated the methodology by simulating the deployment of an immunization guideline in a real clinical information system and by reconstructing the workflow context of a deployed decision-support system for guideline-based care. We discuss the implication of deployment-driven guideline encoding for sharability of executable guidelines.


Subject(s)
Decision Support Systems, Clinical , Immunization , Practice Guidelines as Topic , Decision Making, Computer-Assisted , Humans , Hypertension/drug therapy , Medical Records Systems, Computerized , Models, Theoretical , Retrospective Studies , Software , User-Computer Interface , Vocabulary, Controlled
4.
Conf Proc IEEE Eng Med Biol Soc ; 2004: 3217-20, 2004.
Article in English | MEDLINE | ID: mdl-17270965

ABSTRACT

Clinical practice guidelines have begun to appear in electronic form with the expectation that they will be used to provide automated clinical decision support. Systems capable of executing these clinical practice guidelines are emerging concurrently. A few research projects have developed guideline authoring tools that allow encoding electronic clinical practice guidelines. However, we are not aware of tools that allow testing of electronic clinical practice guidelines by their authors. We have developed a tool called SAGEDesktop for the testing of electronic clinical practice guidelines. SAGEDesktop does not require external infrastructure to carry out this testing. It includes: 1) an embedded guideline engine which can execute electronic clinical practice guidelines 2) functionality that emulates the capabilities of a clinical information system necessary for the execution of the guideline, and 3) terminology server functionality that encapsulates standard clinical terms. Coupled with an authoring tool, SAGEDesktop provides a complete development environment in which precise and robust electronic clinical practice guidelines can be encoded and tested. We describe the features of SAGEDesktop, narrate our vision of the tool's use, and discuss SAGEDesktop's strengths and weaknesses.

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