Skip to main content
PMC home page
Proceedings of the AMIA Symposium logoLink to Proceedings of the AMIA Symposium
. 2000:843–847.

ActiveGuidelines: integrating Web-based guidelines with computer-based patient records.

P C Tang 1, C Y Young 1
PMCID: PMC2243807  PMID: 11080003

Abstract

Use of the World Wide Web provides an efficient means to disseminate guidelines, but integrating them into the workflow at the point of care remains elusive. We developed a method, ActiveGuidelines (AGL), of integrating web-based guidelines with computer-based patient record (CPR) systems. An ActiveGuideline is an HTML document containing special tags that are interpreted by a CPR as actions (e.g., medication order, test order, referral, patient instructions). In our usage scenario, the CPR automatically displays ActiveGuidelines relevant to the current patient context. After reviewing the guideline, the user selects recommended orders directly from the ActiveGuideline. The selected orders are automatically transmitted to the CPR and executed as regular orders. An ActiveGuideline editor facilitates easy conversion of existing HTML-formatted guidelines into ActiveGuidelines. We believe that integrating patient-specific ActiveGuidelines within a CPR system will improve utilization of clinical guidelines in routine patient care.

Full text

PDF
847

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Audet A. M., Greenfield S., Field M. Medical practice guidelines: current activities and future directions. Ann Intern Med. 1990 Nov 1;113(9):709–714. doi: 10.7326/0003-4819-113-9-709. [DOI] [PubMed] [Google Scholar]
  2. Barnes M., Barnett G. O. An architecture for a distributed guideline server. Proc Annu Symp Comput Appl Med Care. 1995:233–237. [PMC free article] [PubMed] [Google Scholar]
  3. Bates D. W., Boyle D. L., Teich J. M. Impact of computerized physician order entry on physician time. Proc Annu Symp Comput Appl Med Care. 1994:996–996. [PMC free article] [PubMed] [Google Scholar]
  4. Chueh H. C., Raila W. F., Berkowicz D. A., Barnett G. O. An XML portable chart format. Proc AMIA Symp. 1998:730–734. [PMC free article] [PubMed] [Google Scholar]
  5. Dubey A. K., Chueh H. Using the extensible markup language (XML) in automated clinical practice guidelines. Proc AMIA Symp. 1998:735–739. [PMC free article] [PubMed] [Google Scholar]
  6. Grimshaw J. M., Russell I. T. Effect of clinical guidelines on medical practice: a systematic review of rigorous evaluations. Lancet. 1993 Nov 27;342(8883):1317–1322. doi: 10.1016/0140-6736(93)92244-n. [DOI] [PubMed] [Google Scholar]
  7. Haynes R. B. Some problems in applying evidence in clinical practice. Ann N Y Acad Sci. 1993 Dec 31;703:210–225. doi: 10.1111/j.1749-6632.1993.tb26350.x. [DOI] [PubMed] [Google Scholar]
  8. Johnston M. E., Langton K. B., Haynes R. B., Mathieu A. Effects of computer-based clinical decision support systems on clinician performance and patient outcome. A critical appraisal of research. Ann Intern Med. 1994 Jan 15;120(2):135–142. doi: 10.7326/0003-4819-120-2-199401150-00007. [DOI] [PubMed] [Google Scholar]
  9. 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]
  10. Lui K. J., Kendal A. P. Impact of influenza epidemics on mortality in the United States from October 1972 to May 1985. Am J Public Health. 1987 Jun;77(6):712–716. doi: 10.2105/ajph.77.6.712. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. McDonald C. J., Hui S. L., Tierney W. M. Effects of computer reminders for influenza vaccination on morbidity during influenza epidemics. MD Comput. 1992 Sep-Oct;9(5):304–312. [PubMed] [Google Scholar]
  12. McDonald C. J., Tierney W. M. The Medical Gopher--a microcomputer system to help find, organize and decide about patient data. West J Med. 1986 Dec;145(6):823–829. [PMC free article] [PubMed] [Google Scholar]
  13. Musen M. A., Gennari J. H., Eriksson H., Tu S. W., Puerta A. R. PROTEGE-II: computer support for development of intelligent systems from libraries of components. Medinfo. 1995;8(Pt 1):766–770. [PubMed] [Google Scholar]
  14. 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]
  15. Nichol K. L., Margolis K. L., Wuorenma J., Von Sternberg T. The efficacy and cost effectiveness of vaccination against influenza among elderly persons living in the community. N Engl J Med. 1994 Sep 22;331(12):778–784. doi: 10.1056/NEJM199409223311206. [DOI] [PubMed] [Google Scholar]
  16. 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]
  17. Overhage J. M., Tierney W. M., Zhou X. H., McDonald C. J. A randomized trial of "corollary orders" to prevent errors of omission. J Am Med Inform Assoc. 1997 Sep-Oct;4(5):364–375. doi: 10.1136/jamia.1997.0040364. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Shea S., DuMouchel W., Bahamonde L. A meta-analysis of 16 randomized controlled trials to evaluate computer-based clinical reminder systems for preventive care in the ambulatory setting. J Am Med Inform Assoc. 1996 Nov-Dec;3(6):399–409. doi: 10.1136/jamia.1996.97084513. [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. Shiffman R. N. Representation of clinical practice guidelines in conventional and augmented decision tables. J Am Med Inform Assoc. 1997 Sep-Oct;4(5):382–393. doi: 10.1136/jamia.1997.0040382. [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. Shortliffe E. H. Computer programs to support clinical decision making. JAMA. 1987 Jul 3;258(1):61–66. [PubMed] [Google Scholar]
  21. Sullivan F., Mitchell E. Has general practitioner computing made a difference to patient care? A systematic review of published reports. BMJ. 1995 Sep 30;311(7009):848–852. doi: 10.1136/bmj.311.7009.848. [DOI] [PMC free article] [PubMed] [Google Scholar]
  22. Tierney W. M., Miller M. E., Overhage J. M., McDonald C. J. Physician inpatient order writing on microcomputer workstations. Effects on resource utilization. JAMA. 1993 Jan 20;269(3):379–383. [PubMed] [Google Scholar]
  23. Tierney W. M., Overhage J. M., McDonald C. J. Computerizing guidelines: factors for success. Proc AMIA Annu Fall Symp. 1996:459–462. [PMC free article] [PubMed] [Google Scholar]
  24. Tierney W. M., Overhage J. M., Takesue B. Y., Harris L. E., Murray M. D., Vargo D. L., McDonald C. J. Computerizing guidelines to improve care and patient outcomes: the example of heart failure. J Am Med Inform Assoc. 1995 Sep-Oct;2(5):316–322. doi: 10.1136/jamia.1995.96073834. [DOI] [PMC free article] [PubMed] [Google Scholar]
  25. Zielstorff R. D. Online practice guidelines: issues, obstacles, and future prospects. J Am Med Inform Assoc. 1998 May-Jun;5(3):227–236. doi: 10.1136/jamia.1998.0050227. [DOI] [PMC free article] [PubMed] [Google Scholar]

Articles from Proceedings of the AMIA Symposium are provided here courtesy of American Medical Informatics Association

RESOURCES