title: Modeling guidelines for integration into clinical workflow.
abstract: 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.
authors.affiliation: Department of Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA. tu@smi.stanford.edu
authors.forename: Samson W
authors.initials: SW
authors.lastname: Tu
authors.forename: Mark A
authors.initials: MA
authors.lastname: Musen
authors.forename: Ravi
authors.initials: R
authors.lastname: Shankar
authors.forename: James
authors.initials: J
authors.lastname: Campbell
authors.forename: Karen
authors.initials: K
authors.lastname: Hrabak
authors.forename: James
authors.initials: J
authors.lastname: McClay
authors.forename: Stanley M
authors.initials: SM
authors.lastname: Huff
authors.forename: Robert
authors.initials: R
authors.lastname: McClure
authors.forename: Craig
authors.initials: C
authors.lastname: Parker
authors.forename: Roberto
authors.initials: R
authors.lastname: Rocha
authors.forename: Robert
authors.initials: R
authors.lastname: Abarbanel
authors.forename: Nick
authors.initials: N
authors.lastname: Beard
authors.forename: Julie
authors.initials: J
authors.lastname: Glasgow
authors.forename: Guy
authors.initials: G
authors.lastname: Mansfield
authors.forename: Prabhu
authors.initials: P
authors.lastname: Ram
authors.forename: Qin
authors.initials: Q
authors.lastname: Ye
authors.forename: Eric
authors.initials: E
authors.lastname: Mays
authors.forename: Tony
authors.initials: T
authors.lastname: Weida
authors.forename: Christopher G
authors.initials: CG
authors.lastname: Chute
authors.forename: Kevin
authors.initials: K
authors.lastname: McDonald
authors.forename: David
authors.initials: D
authors.lastname: Molu
authors.forename: Mark A
authors.initials: MA
authors.lastname: Nyman
authors.forename: Sidna
authors.initials: S
authors.lastname: Scheitel
authors.forename: Harold
authors.initials: H
authors.lastname: Solbrig
authors.forename: David A
authors.initials: DA
authors.lastname: Zill
authors.forename: Mary K
authors.initials: MK
authors.lastname: Goldstein
mesh_terms: D003658:Decision Making, Computer-Assisted; D020000:Decision Support Systems, Clinical; D006801:Humans; D006973:Hypertension / Q000188:drug therapy; D007114:Immunization; D016347:Medical Records Systems, Computerized; D008962:Models, Theoretical; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies; D012984:Software; D014584:User-Computer Interface; D018875:Vocabulary, Controlled