Skip to main content
SpringerLink
Log in

ST-Audit: guideline-based automatic auditing of electronic patient records

  • Published:
Journal of Intelligent Information Systems Aims and scope Submit manuscript

Abstract

This work presents the ST-Audit system that audits a patient record for conformance to a particular clinical guideline. The system uses ST-Guide which models a guideline as a set of states and transitions. The audit system tries to find a path in the state/transition diagram that corresponds to the actions taken by the physician, taking into consideration issues such as the unavailability of all the data needed to evaluate the transitions. The system was used to audit an outpatient clinic regarding their procedure for hypertension treatment (using the VI JNC guideline for hypertension), and the results of the number of non-compliant actions were presented and discussed. A follow up auditing showed a small but statistically significant reduction on the number of non-compliant actions for patients treated after the first audit.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7

Similar content being viewed by others

Notes

  1. We would like to thank an anonymous reviewer for pointing out this example.

References

  • Advani, A., & Musen, Y. (2002). Medical quality assessment by scoring adherence to guideline intentions. Journal of the American Medical Informatics Association, 9, 92–97.

    Article  Google Scholar 

  • Advani, A., Lo, K., & Shahar, Y. (1998). Intention-based critiquing of guideline-oriented medical care. In Proceedings of the 1998 AMIA annual symposium (pp. 483–487).

  • Boxwala, A. A., Peleg, M., Tu, S., Ogunyemi, O., Zeng, Q. T., Wang, D., et al. (2004). GLIF3: A representation format for sharable computer-interpretable clinical practice guidelines. Journal of Biomedical Informatics, 37(3), 147–161.

    Article  Google Scholar 

  • Chesani, F., Lamma, E., Mello, P., Montali, M., Storari, S., Baldazzi, P., et al. (2008). Compliance checking of cancer-screening CareFlows: An approach based on computational logic. In A. Ten Teije, et al. (Eds.), Computer-based medical guidelines and protocols: A primer and current trends: A primer and current trends (p. 183). Fairfax: IOS.

    Google Scholar 

  • Clarke, E., Grumberg, O., & Peled, D. (1999). Model checking. Cambridge: MIT.

    Google Scholar 

  • Corrigan, J. M., Donaldson, M. S., & Kohn, L. T. (2001). Crossing the quality chasm: A new health system for the 21st century. National Academy Press.

  • de Clercq, P. A., Blom, J. A., Korsten, H. H. M., & Hasman, A. (2004). Approaches for creating computer-interpretable guidelines that facilitate decision support. Artificial Intelligence in Medicine, 31(1), 1–27.

    Article  Google Scholar 

  • Dick, R. S., Steen, E. B., & Demer, D. E. (1997) The computer-based patient record: An essential technology for health care. Washington, DC: National Academy.

    Google Scholar 

  • Ellis, N. T. (1997). C.A.S.M. and C.A.S.T.: A new information based approach to clinical audit. Computer Methods and Programs in Biomedicine, 54, 29–38.

    Article  Google Scholar 

  • Fox, J., Johns, N., & Rahmanzadeh, A. (1998). Disseminating medical knowledge: The PROforma approach. Artificial Intelligence in Medicine, 14(1–2), 157–182.

    Article  Google Scholar 

  • Grimshaw, J. M., & Russell, I. T. (1993). Effect of clinical guidelines on medical practice: A systematic review of rigorous evaluations. Lancet, 342(8883), 1317–1322.

    Article  Google Scholar 

  • Groot, P., Hommersom, A., Lucas, P., Serban, R., ten Teije, A., & van Harmelen, F. (2007). The role of model checking in critiquing based on clinical guidelines. In 11th conference on artificial intelligence in medicine, AIME 2007, Lecture Notes in Computer Science (Vol. 4594, pp. 411–420). Springer, Berlin.

    Google Scholar 

  • Hazlehurst, B., Sittig, D. F., Stevens, V. J., Smith, K. S., Hollis, F. H., Vogt, T. M., et al. (2005) Natural language processing in the electronic medical record—assessing clinical adherence to tobacco treatment guidelines. American Journal of Preventive Medicine, 29, 434–439.

    Article  Google Scholar 

  • Hripcsak, G., Ludemann, P., Pryor, T. A., Wigertz, O. B., & Clayton, P. D. (1994). Rationale for the Arden syntax. Computers and Biomedical Research, 27(4), 291–324.

    Article  Google Scholar 

  • Johnson, P. D., Tu, S. W., Booth, N., Sugden, B., & Purves, I. N. (2000). Using scenarios in chronic disease management guidelines for primary care. In Proc. AMIA Symp. (pp. 389–393).

  • Kinn, S., Lee, N., & Millman, A. (1995). ABC of medical computing: Using computers in clinical audit. BMJ, 311, 739–742.

    Google Scholar 

  • Kuilboer, M. M., van der Lei, J., de Jongste, J. C., Overbeek, S. E., Ponsioen, B., & van Bemmel, J. H. (1998). Simulating an integrated critiquing system. Journal of the American Medical Informatics Association, 5, 194–202.

    Google Scholar 

  • Kuilboer, M. M., van Wijk, M. A. M., Mosseveld, M., & van der Lei, J. (2003). AsthmaCritic: Issues in designing a noninquisitive critiquing system for daily practice. Journal of the American Medical Informatics Association, 10(5), 419–424.

    Article  Google Scholar 

  • Kuilboer, M. M., van Wijk, M. A. M., Mosseveld, M., van der Does, E., de Jongste, J. C., Overbeek, S. E., et al. (2006). Computed critiquing integrated into daily clinical practice affects physicians’ behavior—a randomized clinical trial with AsthmaCritic. Methods of Information in Medicine, 45(4), 447–454.

    Google Scholar 

  • Landon, B. E., Normand, S. T., Blumenthal, D., & Daley, J. (2003). Physician clinical performance assessment—prospects and barriers. JAMA, 290(9), 1183–1189.

    Article  Google Scholar 

  • McMillan, K. L. (1993). Symbolic model checking. Norwell: Kluwer.

    MATH  Google Scholar 

  • Montani, S. (2007). Case-based reasoning for managing non-compliance with clinical guidelines. Proc. case-based reasoning in the health sciences workshop, International Conference on Case Based Reasoning (ICCBR), August.

  • Monteiro, A., & Wainer, J. (2001). A conceptual framework to model chronic and long-term diseases. In 8th Conference on artificial intelligence in medicine in Europe—AIME, LNAI (Vol. 2101, pp. 405–408). Berlin: Springer.

    Google Scholar 

  • National Institute for Clinical Excellence (2002). Principles for best practice in clinical audit. Oxford: Radcliffe Medical. http://www.nice.org.uk/niceMedia/pdf/BestPracticeClinicalAudit.pdf.

    Google Scholar 

  • National Institutes of Health (1997). The sixth report of the join national committee on prevention, detection, evaluation, and treatment of high blood pressure. www.ncbi.nlm.nih.gov/books/bookres.fcgi/hbp/hbp.pdf.

  • Ohno-Machado, L., Gennari, J. H., Murphy, S. N., Jain, N. L., Tu, S. W., Oliver, D. E., et al. (1998). The guideline interchange format. Journal of the American Medical Informatics Association, 5, 357–372.

    Google Scholar 

  • Schneider, E. C., Riehl, V., Courte-Winecke, S., Eddy, D. M., & Sennet, C. (1999). Enhancing performance measurement—NCQA’s road map for a health information framework. JAMA, 282, 1184–1190.

    Article  Google Scholar 

  • Schnoebelen, P. (2002). The complexity of temporal logic model checking. Advances in Modal Logic, 4, 1–44.

    Google Scholar 

  • Shahar, Y., Miksch, S., & Johnson, P. (1998). The Asgaard project: A task-specific framework for the application and critiquing of time-oriented clinical guidelines. Artificial Intelligence in Medicine, 14(1–2), 29–51.

    Article  Google Scholar 

  • Shakib, S., & Phillips, P. A. (2003). The Australian centre for evidence-based clinical practice generic audit tool: Auditmaker for health professionals. Journal of Evaluation in Clinical Practice, 9(2):259–263.

    Article  Google Scholar 

  • Shiffman, R. N., Liaw, Y., Brandt, C. A., & Corb, G. J. (1999). Computer-based guideline implementation systems. Journal of the American Medical Informatics Association, 6, 104–114.

    Google Scholar 

  • Sips, R., Braun, L., & Roos, N. (2006). Applying intention-based guidelines for critiquing. In Workshop: AI techniques in healthcare: Evidence-based guidelines and protocols. http://www.openclinical.org/cgp2006_2.html#critiquing.

  • Tu, S. W., & Musen, M. A. (2001). Representation formalisms and computational methods for modeling guideline-based patient care. In B. Heller, M. Loffler, M. Musen, & M. Stefanelli (Ed.), Computer-based support for clinical guidelines and protocols: Proceedings of EWGLP 2000 (pp. 115–132). IOS Press.

  • van der Lei, J., & Musen, M. A. (1991). A model for critiquing based on automated medical records. Computers and Biomedical Research, 24(4), 344–378.

    Article  Google Scholar 

  • van der Lei, J., Musen, M. A., van der Does, E., & Van Bemmel, J. H. (1991). Review of physician decision making using data from computer-stored medical records. Lancet, 338, 1504–1508.

    Article  Google Scholar 

  • Wainer, J., Billa, C., Paixao, M., & Sigulem, D. (2008). ST-Guide: A framework for the implementation of automatic clinical guidelines. In 23th ACM symposium on applied computing (SAC) (Vol. 2, pp. 1325–1332).

  • Wang, D., Peleg, M., Tu, S. W., Boxwala, A. A., Greenes, R. A., Patel, V. L., et al. (2002). Representation primitives, process models and patient data in computer-interpretable clinical practice guidelines: A literature review of guideline representation models. International Journal of Medical Informatics, 68(1–3), 59–70.

    Article  Google Scholar 

  • Woolf, S. H., Grol, R., Hutchinson, A., Eccles, M., & Grimshaw, J. (1999). Clinical guidelines. potential benefits, limitations, and harms of clinical guidelines. BMJ, 318(7182), 527–530.

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Institute of Computing, University of Campinas, Campinas, 13083-970, São Paulo, Brazil

    Cleo Zanella Billa & Jacques Wainer

  2. Department of Health Informatics, Federal University of Sao Paulo, Sao Paulo, 13083-970, São Paulo, Brazil

    Claudia Barsottini

Authors
  1. Cleo Zanella Billa
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jacques Wainer
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Claudia Barsottini
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jacques Wainer.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Billa, C.Z., Wainer, J. & Barsottini, C. ST-Audit: guideline-based automatic auditing of electronic patient records. J Intell Inf Syst 36, 49–72 (2011). https://doi.org/10.1007/s10844-010-0120-9

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10844-010-0120-9

Keywords

Search

Navigation