Abstract
The success of a decision support system based on clinical practice guidelines does not only depend on the quality of the decision model used to represent and execute guideline recommendations, but also on the design of interactions of the system with the end-user interface and the electronic patient record. This paper describes technical solutions adopted to add decision support functionalities to two existing information systems for stroke patients. Despite the specific medical application, the approach is quite general, relying on two main functionalities: a real-time decision support system based on workflow technology (careflow) and an off-line tool for non-compliance detection, called “Reasoning on Medical Action” (RoMA). The integration has been developed maintaining independence between data management and knowledge management, and minimizing changes to existing user’s interfaces. The paper illustrates in particular the middleware layer created to allow communication between the evidence-based system and the electronic patient record.
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References
Eccles, M.P., Grimshaw, J.M.: Selecting, presenting and delivering clinical guidelines: are there any “magic bullets”? Med. J. Aust. 180(6 Suppl.), S52–S54 (2004)
Prior, M., Guerin, M., Grimmer-Somers, K.: The effectiveness of clinical guideline implementation strategies-a synthesis of systematic review findings. J. Eval. Clin. Pract. 14(5), 888–897 (2008); Review
Groot, P., Hommersom, A., Lucas, P.J., Merk, R.J., ten Teije, A., van Harmelen, F., Serban, R.: Using model checking for critiquing based on clinical guidelines. Artif. Intell. Med. 46(1), 19–36 (2009)
Kawamoto, K., Houlihan, C.A., Balas, E.A., Lobach, D.F.: Improving clinical practice using clinical decision support systems: a systematic review of trials to identify features critical to success. BMJ. 2, 330 (2005)
Moyer, P.: Guidelines for Inpatient Treatment of Stroke Improve Quality of Care. In: 30th International Stroke Conference, New Orleans: Abstract 93 (2005)
Wells, S., Furness, S., Rafter, N., Horn, E., Whittaker, R., Stewart, A., Moodabe, K., Roseman, P., Selak, V., Bramley, D., Jackson, R.: Integrated electronic decision support increases cardiovascular disease risk assessment four fold in routine primary care practice. Eur. J. Cardiovasc. Prev. Rehabil. 15(2), 173–178 (2008)
Eccles, M., McColl, E., Steen, N., Rousseau, N., Grimshaw, J., Parkin, D., Purves, I.: Effect of computerised evidence based guidelines on management of asthma and angina in adults in primary care: cluster randomised controlled trial. BMJ 325, 941 (2002)
Wears, R.L., Berg, M.: Computer Technology and Clinical Work - Still Waiting for Godot. JAMA 293, 1261–1263 (2005)
Green, C.J., Fortin, P., Maclure, M., Macgregor, A., Robinson, S.: Information system support as a critical success factor for chronic disease management: Necessary but not sufficient. Int. J. Med. Inform. 75(12), 818–828 (2006)
Peleg, M., Tu, S., Bury, J., Ciccarese, P., Fox, J., Greenes, R.A., Hall, R., Johnson, P.D., Jones, N., Kumar, A., Miksch, S., Quaglini, S., Seyfang, A., Shortliffe, E.H., Stefanelli, M.: Comparing computer-interpretable guideline models: a case-study approach. J. Am. Med. Inform. Assoc. 10(1), 52–68 (2003)
Middleton, B.: The clinical decision support consortium. Stud. Health Technol. Inform. 150, 26–30 (2009)
Coiera, E.: The Guide to Health Informatics, 2nd edn. Arnold, London (2003)
SPREAD Stroke Prevention and Educational Awareness Diffusion (2003), http://www.spread.it
Panzarasa, S., Bellazzi, R., Larizza, C., Stefanelli, M.: A careflow management system for chronic patients. In: Fieschi, Yu-Chan, C., Li, J. (eds.) MedInfo 2004, pp. 773–777 (2004)
Panzarasa, S., Maddè, S., Quaglini, S., Pistarini, C., Stefanelli, M.: Evidence-based careflow management systems: the case of post-stroke rehabilitation. J. Biomed. Inform. 35(2), 123–139 (2002)
Panzarasa, S., Quaglini, S., Cavallini, A., Marcheselli, S., Stefanelli, M., Micieli, G.: Computerised Guidelines Implementation: Obtaining Feedback for Revision of Guidelines, Clinical Data Model and Data Flow. In: Bellazzi, R., Abu-Hanna, A., Hunter, J. (eds.) AIME 2007. LNCS (LNAI), vol. 4594, pp. 461–466. Springer, Heidelberg (2007)
Shalom, E., Shahar, Y., Lunenfeld, E., Taieb-Maimon, M., Young, O., Goren-Bar, D., et al.: The Importance of Creating an Ontology-Specific Consensus Before a Markup-Based Specification of Clinical Guidelines. In: Proc. ECAI, Riva del Garda, Italy (2006)
Seyfang, A., Miksch, S., Marcos, M., Wittenberg, J., Polo-Conde, C., Rosenbrand, K.: Bridging the Gap between Informal and Formal Guideline Representations. In: Proc. ECAI, Riva del Garda, Italy (2006)
Shiffman, R.N., Michel, G., Essaihi, A., Thornquist, E.: Bridging the guideline implementation gap: a systematic, document-centered approach to guideline implementation. J. Am. Med. Inform. Assoc. 11(5), 418–426 (2004)
Peleg, M., Wang, D., Fodor, A., Keren, S., Karnieli, E.: Lessons learned from adapting a generic narrative diabetic-foot guideline to an institutional decision-support system. Stud. Health Technol. Inform. 139, 243–252 (2008)
German, E., Leibowitz, A., Shahar, Y.: An architecture for linking medical decision-support applications to clinical databases and its evaluation. J. Biomed. Inform. 42(2), 203–218 (2009)
Peleg, M., Keren, S., Denekamp, Y.: Mapping Computerized Clinical Guidelines to Electronic Medical Records: Knowledge-Data Ontological Mapper (KDOM). J. Biomed. Inform. 41(1), 180–201 (2008)
Tu, S.W., Musen, M.A., Shankar, R., Campbell, J., Hrabak, K., McClay, J., et al.: Modeling guidelines for integration into clinical workflow. In: Medinfo 2004, pp. 174–178 (2004)
Panzarasa, S., Quaglini, S., Micieli, G., Marcheselli, S., Pessina, M., Pernice, C., Cavallini, A., Stefanelli, M.: Improving compliance to guidelines through workflow technology: implementation and results in a stroke unit. Stud. Health Technol. Inform. 129, 834–839 (2007)
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Panzarasa, S., Quaglini, S., Cavallini, A., Micieli, G., Marcheselli, S., Stefanelli, M. (2010). Technical Solutions for Integrating Clinical Practice Guidelines with Electronic Patient Records. In: Riaño, D., ten Teije, A., Miksch, S., Peleg, M. (eds) Knowledge Representation for Health-Care. Data, Processes and Guidelines. KR4HC 2009. Lecture Notes in Computer Science(), vol 5943. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-11808-1_12
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DOI: https://doi.org/10.1007/978-3-642-11808-1_12
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