title: Requirements for guidelines systems: implementation challenges and lessons from existing software-engineering efforts.
abstract: BACKGROUND
  A large body of work in the clinical guidelines field has identified requirements for guideline systems, but there are formidable challenges in translating such requirements into production-quality systems that can be used in routine patient care. Detailed analysis of requirements from an implementation perspective can be useful in helping define sub-requirements to the point where they are implementable. Further, additional requirements emerge as a result of such analysis. During such an analysis, study of examples of existing, software-engineering efforts in non-biomedical fields can provide useful signposts to the implementer of a clinical guideline system.
  
  
  METHODS
  In addition to requirements described by guideline-system authors, comparative reviews of such systems, and publications discussing information needs for guideline systems and clinical decision support systems in general, we have incorporated additional requirements related to production-system robustness and functionality from publications in the business workflow domain, in addition to drawing on our own experience in the development of the Proteus guideline system (http://proteme.org).
  
  
  RESULTS
  The sub-requirements are discussed by conveniently grouping them into the categories used by the review of Isern and Moreno 2008. We cite previous work under each category and then provide sub-requirements under each category, and provide example of similar work in software-engineering efforts that have addressed a similar problem in a non-biomedical context.
  
  
  CONCLUSIONS
  When analyzing requirements from the implementation viewpoint, knowledge of successes and failures in related software-engineering efforts can guide implementers in the choice of effective design and development strategies.
authors.affiliation: Henry Ford Health System, Detroit, USA. proteme@gmail.com
authors.forename: Hemant
authors.initials: H
authors.lastname: Shah
authors.forename: Raymond D
authors.initials: RD
authors.lastname: Allard
authors.forename: Robert
authors.initials: R
authors.lastname: Enberg
authors.forename: Ganesh
authors.initials: G
authors.lastname: Krishnan
authors.forename: Patricia
authors.initials: P
authors.lastname: Williams
authors.forename: Prakash M
authors.initials: PM
authors.lastname: Nadkarni
mesh_terms: D020000:Decision Support Systems, Clinical / Q000458:organization & administration*; D017410:Practice Guidelines as Topic; D012196:Review Literature as Topic; D012985:Software Design