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Technical Solutions for Integrating Clinical Practice Guidelines with Electronic Patient Records

  • Conference paper
Knowledge Representation for Health-Care. Data, Processes and Guidelines (KR4HC 2009)

Part of the book series: Lecture Notes in Computer Science ((LNAI,volume 5943))

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Abstract

The success of a decision support system based on clinical practice guidelines does not only depend on the quality of the decision model used to represent and execute guideline recommendations, but also on the design of interactions of the system with the end-user interface and the electronic patient record. This paper describes technical solutions adopted to add decision support functionalities to two existing information systems for stroke patients. Despite the specific medical application, the approach is quite general, relying on two main functionalities: a real-time decision support system based on workflow technology (careflow) and an off-line tool for non-compliance detection, called “Reasoning on Medical Action” (RoMA). The integration has been developed maintaining independence between data management and knowledge management, and minimizing changes to existing user’s interfaces. The paper illustrates in particular the middleware layer created to allow communication between the evidence-based system and the electronic patient record.

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References

  1. Eccles, M.P., Grimshaw, J.M.: Selecting, presenting and delivering clinical guidelines: are there any “magic bullets”? Med. J. Aust. 180(6 Suppl.), S52–S54 (2004)

    Google Scholar 

  2. Prior, M., Guerin, M., Grimmer-Somers, K.: The effectiveness of clinical guideline implementation strategies-a synthesis of systematic review findings. J. Eval. Clin. Pract. 14(5), 888–897 (2008); Review

    Article  Google Scholar 

  3. Groot, P., Hommersom, A., Lucas, P.J., Merk, R.J., ten Teije, A., van Harmelen, F., Serban, R.: Using model checking for critiquing based on clinical guidelines. Artif. Intell. Med. 46(1), 19–36 (2009)

    Article  Google Scholar 

  4. Kawamoto, K., Houlihan, C.A., Balas, E.A., Lobach, D.F.: Improving clinical practice using clinical decision support systems: a systematic review of trials to identify features critical to success. BMJ. 2, 330 (2005)

    Google Scholar 

  5. Moyer, P.: Guidelines for Inpatient Treatment of Stroke Improve Quality of Care. In: 30th International Stroke Conference, New Orleans: Abstract 93 (2005)

    Google Scholar 

  6. Wells, S., Furness, S., Rafter, N., Horn, E., Whittaker, R., Stewart, A., Moodabe, K., Roseman, P., Selak, V., Bramley, D., Jackson, R.: Integrated electronic decision support increases cardiovascular disease risk assessment four fold in routine primary care practice. Eur. J. Cardiovasc. Prev. Rehabil. 15(2), 173–178 (2008)

    Article  Google Scholar 

  7. Eccles, M., McColl, E., Steen, N., Rousseau, N., Grimshaw, J., Parkin, D., Purves, I.: Effect of computerised evidence based guidelines on management of asthma and angina in adults in primary care: cluster randomised controlled trial. BMJ 325, 941 (2002)

    Article  Google Scholar 

  8. Wears, R.L., Berg, M.: Computer Technology and Clinical Work - Still Waiting for Godot. JAMA 293, 1261–1263 (2005)

    Article  Google Scholar 

  9. Green, C.J., Fortin, P., Maclure, M., Macgregor, A., Robinson, S.: Information system support as a critical success factor for chronic disease management: Necessary but not sufficient. Int. J. Med. Inform. 75(12), 818–828 (2006)

    Article  Google Scholar 

  10. Peleg, M., Tu, S., Bury, J., Ciccarese, P., Fox, J., Greenes, R.A., Hall, R., Johnson, P.D., Jones, N., Kumar, A., Miksch, S., Quaglini, S., Seyfang, A., Shortliffe, E.H., Stefanelli, M.: Comparing computer-interpretable guideline models: a case-study approach. J. Am. Med. Inform. Assoc. 10(1), 52–68 (2003)

    Article  Google Scholar 

  11. Middleton, B.: The clinical decision support consortium. Stud. Health Technol. Inform. 150, 26–30 (2009)

    Google Scholar 

  12. Coiera, E.: The Guide to Health Informatics, 2nd edn. Arnold, London (2003)

    Book  Google Scholar 

  13. SPREAD Stroke Prevention and Educational Awareness Diffusion (2003), http://www.spread.it

  14. Panzarasa, S., Bellazzi, R., Larizza, C., Stefanelli, M.: A careflow management system for chronic patients. In: Fieschi, Yu-Chan, C., Li, J. (eds.) MedInfo 2004, pp. 773–777 (2004)

    Google Scholar 

  15. Panzarasa, S., Maddè, S., Quaglini, S., Pistarini, C., Stefanelli, M.: Evidence-based careflow management systems: the case of post-stroke rehabilitation. J. Biomed. Inform. 35(2), 123–139 (2002)

    Article  Google Scholar 

  16. Panzarasa, S., Quaglini, S., Cavallini, A., Marcheselli, S., Stefanelli, M., Micieli, G.: Computerised Guidelines Implementation: Obtaining Feedback for Revision of Guidelines, Clinical Data Model and Data Flow. In: Bellazzi, R., Abu-Hanna, A., Hunter, J. (eds.) AIME 2007. LNCS (LNAI), vol. 4594, pp. 461–466. Springer, Heidelberg (2007)

    Chapter  Google Scholar 

  17. Shalom, E., Shahar, Y., Lunenfeld, E., Taieb-Maimon, M., Young, O., Goren-Bar, D., et al.: The Importance of Creating an Ontology-Specific Consensus Before a Markup-Based Specification of Clinical Guidelines. In: Proc. ECAI, Riva del Garda, Italy (2006)

    Google Scholar 

  18. Seyfang, A., Miksch, S., Marcos, M., Wittenberg, J., Polo-Conde, C., Rosenbrand, K.: Bridging the Gap between Informal and Formal Guideline Representations. In: Proc. ECAI, Riva del Garda, Italy (2006)

    Google Scholar 

  19. Shiffman, R.N., Michel, G., Essaihi, A., Thornquist, E.: Bridging the guideline implementation gap: a systematic, document-centered approach to guideline implementation. J. Am. Med. Inform. Assoc. 11(5), 418–426 (2004)

    Article  Google Scholar 

  20. Peleg, M., Wang, D., Fodor, A., Keren, S., Karnieli, E.: Lessons learned from adapting a generic narrative diabetic-foot guideline to an institutional decision-support system. Stud. Health Technol. Inform. 139, 243–252 (2008)

    Google Scholar 

  21. German, E., Leibowitz, A., Shahar, Y.: An architecture for linking medical decision-support applications to clinical databases and its evaluation. J. Biomed. Inform. 42(2), 203–218 (2009)

    Article  Google Scholar 

  22. Peleg, M., Keren, S., Denekamp, Y.: Mapping Computerized Clinical Guidelines to Electronic Medical Records: Knowledge-Data Ontological Mapper (KDOM). J. Biomed. Inform. 41(1), 180–201 (2008)

    Article  Google Scholar 

  23. Tu, S.W., Musen, M.A., Shankar, R., Campbell, J., Hrabak, K., McClay, J., et al.: Modeling guidelines for integration into clinical workflow. In: Medinfo 2004, pp. 174–178 (2004)

    Google Scholar 

  24. Panzarasa, S., Quaglini, S., Micieli, G., Marcheselli, S., Pessina, M., Pernice, C., Cavallini, A., Stefanelli, M.: Improving compliance to guidelines through workflow technology: implementation and results in a stroke unit. Stud. Health Technol. Inform. 129, 834–839 (2007)

    Google Scholar 

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Author information

Authors and Affiliations

  1. CBIM Consorzio di Bioingegneria e Informatica Medica, Pavia, Italy

    Silvia Panzarasa

  2. Department of Computer Engineering and Systems Science, University of Pavia, Italy

    Silvana Quaglini & Mario Stefanelli

  3. IRCCS C. Mondino Foundation, Pavia, Italy

    Anna Cavallini & Giuseppe Micieli

  4. IRCCS Humanitas, Rozzano, (MI), Italy

    Simona Marcheselli

Authors
  1. Silvia Panzarasa
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  2. Silvana Quaglini
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  3. Anna Cavallini
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  4. Giuseppe Micieli
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  5. Simona Marcheselli
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  6. Mario Stefanelli
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Editor information

Editors and Affiliations

  1. Rovira i Virgili University, Av. Països Catalans 26, 43007, Tarragona, Spain

    David Riaño

  2. Free University Amsterdam, De Boelelaan 1081A, 1081HV, Amsterdam, The Netherlands

    Annette ten Teije

  3. Danube University Krems, Dr.-Karl-Dorrek-Str. 30, 3500, Krems, Austria

    Silvia Miksch

  4. University of Haifa, Rabin Bldg, 31905, Haifa, Israel

    Mor Peleg

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Panzarasa, S., Quaglini, S., Cavallini, A., Micieli, G., Marcheselli, S., Stefanelli, M. (2010). Technical Solutions for Integrating Clinical Practice Guidelines with Electronic Patient Records. In: Riaño, D., ten Teije, A., Miksch, S., Peleg, M. (eds) Knowledge Representation for Health-Care. Data, Processes and Guidelines. KR4HC 2009. Lecture Notes in Computer Science(), vol 5943. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-11808-1_12

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  • DOI: https://doi.org/10.1007/978-3-642-11808-1_12

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-642-11807-4

  • Online ISBN: 978-3-642-11808-1

  • eBook Packages: Computer ScienceComputer Science (R0)

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