Abstract
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.
Full text
PDFSelected References
These references are in PubMed. This may not be the complete list of references from this article.
- Advani A., Lo K., Shahar Y. Intention-based critiquing of guideline-oriented medical care. Proc AMIA Symp. 1998:483–487. [PMC free article] [PubMed] [Google Scholar]
- Dazzi L., Fassino C., Saracco R., Quaglini S., Stefanelli M. A patient workflow management system built on guidelines. Proc AMIA Annu Fall Symp. 1997:146–150. [PMC free article] [PubMed] [Google Scholar]
- Fox J., Johns N., Rahmanzadeh A. Disseminating medical knowledge: the PROforma approach. Artif Intell Med. 1998 Sep-Oct;14(1-2):157–181. doi: 10.1016/s0933-3657(98)00021-9. [DOI] [PubMed] [Google Scholar]
- Headrick L. A., Speroff T., Pelecanos H. I., Cebul R. D. Efforts to improve compliance with the National Cholesterol Education Program guidelines. Results of a randomized controlled trial. Arch Intern Med. 1992 Dec;152(12):2490–2496. [PubMed] [Google Scholar]
- Lobach D. F., Gadd C. S., Hales J. W. Structuring clinical practice guidelines in a relational database model for decision support on the Internet. Proc AMIA Annu Fall Symp. 1997:158–162. [PMC free article] [PubMed] [Google Scholar]
- Lobach D. F., Hammond W. E. Computerized decision support based on a clinical practice guideline improves compliance with care standards. Am J Med. 1997 Jan;102(1):89–98. doi: 10.1016/s0002-9343(96)00382-8. [DOI] [PubMed] [Google Scholar]
- Musen M. A., Tu S. W., Das A. K., Shahar Y. EON: a component-based approach to automation of protocol-directed therapy. J Am Med Inform Assoc. 1996 Nov-Dec;3(6):367–388. doi: 10.1136/jamia.1996.97084511. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Nilasena D. S., Lincoln M. J. A computer-generated reminder system improves physician compliance with diabetes preventive care guidelines. Proc Annu Symp Comput Appl Med Care. 1995:640–645. [PMC free article] [PubMed] [Google Scholar]
- Ohno-Machado L., Gennari J. H., Murphy S. N., Jain N. L., Tu S. W., Oliver D. E., Pattison-Gordon E., Greenes R. A., Shortliffe E. H., Barnett G. O. The guideline interchange format: a model for representing guidelines. J Am Med Inform Assoc. 1998 Jul-Aug;5(4):357–372. doi: 10.1136/jamia.1998.0050357. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Shahar Y., Miksch S., Johnson P. The Asgaard project: a task-specific framework for the application and critiquing of time-oriented clinical guidelines. Artif Intell Med. 1998 Sep-Oct;14(1-2):29–51. doi: 10.1016/s0933-3657(98)00015-3. [DOI] [PubMed] [Google Scholar]
- Weingarten S., Stone E., Hayward R., Tunis S., Pelter M., Huang H., Kristopaitis R. The adoption of preventive care practice guidelines by primary care physicians: do actions match intentions? J Gen Intern Med. 1995 Mar;10(3):138–144. doi: 10.1007/BF02599668. [DOI] [PubMed] [Google Scholar]
- Zielstorff R. D., Teich J. M., Paterno M. D., Segal M., Kuperman G. J., Hiltz F. L., Fox R. L. P-CAPE: a high-level tool for entering and processing clinical practice guidelines. Partners Computerized Algorithm and Editor. Proc AMIA Symp. 1998:478–482. [PMC free article] [PubMed] [Google Scholar]