title: Trade-offs in producing patient-specific recommendations from a computer-based clinical guideline: a case study.
abstract: This case study explored 1) how much online clinical data is required to obtain patient-specific recommendations from a computer-based clinical practice guideline, 2) whether the availability of increasing amounts of online clinical data might allow a higher specificity of those recommendations, and 3) whether that increased specificity is necessarily desirable. The "quick reference guide" version of the guideline for acute postoperative pain management in adults, developed by the Agency for Health Care Policy and Research, was analyzed. Patient-specific data items that might be used to tailor the computer's output for a particular case were grouped into rough categories depending on how likely they were to be available online and how readily they might be determined from online clinical data. The patient-specific recommendations were analyzed to determine to what degree the amount of text produced depended on the online availability of different categories of data. An examination of example recommendations, however, illustrated that high specificity may not always be desirable. The study provides a concrete illustration of how the richness of online clinical data can affect patient-specific recommendations, and describes a number of related design trade-offs in converting a clinical guideline into an interactive, computer-based form.
authors.affiliation: Center for Medical Informatics, Yale University School of Medicine, New Haven, CT 06520-8009, USA.
authors.forename: P L
authors.initials: PL
authors.lastname: Miller
authors.forename: S J
authors.initials: SJ
authors.lastname: Frawley
mesh_terms: D000328:Adult; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D003658:Decision Making, Computer-Assisted; D006801:Humans; D009294:Narcotics / Q000627:therapeutic use; D009862:Online Systems; D010149:Postoperative Pain / Q000188:drug therapy; D017410:Practice Guidelines as Topic; D012680:Sensitivity and Specificity
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D009294:Narcotics