Stanley M. Huff

Modeling guidelines for integration into clinical workflow.

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.

Chapter 17 – Ontologies, Vocabularies and Data Models

The purpose of this chapter is to describe current vocabulary and terminology issues and challenges related specifically to the successful implementation of clinical decision support (CDS) systems. The chapter discusses: why standard coded data are essential for accurate and reliable execution of decision logic; how to unambiguously reference data in the electronic health record (EHR) from CDS expressions; alternatives for pre- and post-coordinated representations of data; representation of patient data as name-value pairs; the relationship between terms and information/data models which provide the context of use; terminology in the life cycle of CDS; the next steps that are needed in standardizing models and terminology for use in CDS.