RESUMO
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.
Assuntos
Sistemas de Apoio a Decisões Clínicas , Imunização , Guias de Prática Clínica como Assunto , Tomada de Decisões Assistida por Computador , Humanos , Hipertensão/tratamento farmacológico , Sistemas Computadorizados de Registros Médicos , Modelos Teóricos , Estudos Retrospectivos , Software , Interface Usuário-Computador , Vocabulário ControladoRESUMO
We report the first successful test of an interoperable guideline execution engine that interprets encoded clinical guideline content and executes that content via functions of a target clinical information system (CIS). For this test, an exemplar immunization guideline was encoded in the SAGE guideline model using standards-based information models and terminologies. This guideline content was subsequently executed using the prototype SAGE guideline execution engine, which interacts through standards-based VMR/Action services to instantiate real-time guideline recommendations via existing functions of the target CIS. In this paper, we describe our test implementation and highlight the significance and implications of each component of our deployment architecture
