title: A study of diverse clinical decision support rule authoring environments and requirements for integration.
abstract: BACKGROUND
  Efficient rule authoring tools are critical to allow clinical Knowledge Engineers (KEs), Software Engineers (SEs), and Subject Matter Experts (SMEs) to convert medical knowledge into machine executable clinical decision support rules. The goal of this analysis was to identify the critical success factors and challenges of a fully functioning Rule Authoring Environment (RAE) in order to define requirements for a scalable, comprehensive tool to manage enterprise level rules.
  
  
  METHODS
  The authors evaluated RAEs in active use across Partners Healthcare, including enterprise wide, ambulatory only, and system specific tools, with a focus on rule editors for reminder and medication rules. We conducted meetings with users of these RAEs to discuss their general experience and perceived advantages and limitations of these tools.
  
  
  RESULTS
  While the overall rule authoring process is similar across the 10 separate RAEs, the system capabilities and architecture vary widely. Most current RAEs limit the ability of the clinical decision support (CDS) interventions to be standardized, sharable, interoperable, and extensible. No existing system meets all requirements defined by knowledge management users.
  
  
  CONCLUSIONS
  A successful, scalable, integrated rule authoring environment will need to support a number of key requirements and functions in the areas of knowledge representation, metadata, terminology, authoring collaboration, user interface, integration with electronic health record (EHR) systems, testing, and reporting.
authors.affiliation: Clinical Informatics Research and Development, Partners HealthCare, 93 Worcester Street, 2nd floor, Wellesley, MA 02481, USA. lzhou2@partners.org
authors.forename: Li
authors.initials: L
authors.lastname: Zhou
authors.forename: Neelima
authors.initials: N
authors.lastname: Karipineni
authors.forename: Janet
authors.initials: J
authors.lastname: Lewis
authors.forename: Saverio M
authors.initials: SM
authors.lastname: Maviglia
authors.forename: Amanda
authors.initials: A
authors.lastname: Fairbanks
authors.forename: Tonya
authors.initials: T
authors.lastname: Hongsermeier
authors.forename: Blackford
authors.initials: B
authors.lastname: Middleton
authors.forename: Roberto A
authors.initials: RA
authors.lastname: Rocha
mesh_terms: D020000:Decision Support Systems, Clinical; D057286:Electronic Health Records; D050316:Medical Order Entry Systems; D017010:Reminder Systems; D012985:Software Design; D018511:Systems Integration; D014481:United States; D014584:User-Computer Interface