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Vojtech Huser, MD /ebox/11-presentations/ Vojtech Huser, MD Vojtech Huser, MD Journal clubGuidelines article Vojtech Huser, MD November 2004 Agenda Why this article Guidelines background Article Intro Formats Conclusion My comments Our discussion Why this article Recent article on guidelines Focus on execution of a guideline History 1960-1990 diagnostic systems era 1990s crisis 1990-2004 guidelines era Guidelines Types of standards Only markup Executable Why so many standards? Which one is the best SAGE ProForma Tools Editor Execution engine Guidelines (2) M. Peleg at al. Comparing computer-interpretable guideline models: a case-study approach, J Am Med Inform Assoc, vol. 10, pp. 52-68, 2003. /pubs/SMI_Reports/SMI-2002-0923.pdf D. Wang, at al. Representation primitives, process models and patient data in computer-interpretable clinical practice guidelines: A literature review of guideline representation models, Int J Med Inf, vol. 68, pp. 59-70, 2002. /pubs/SMI_Reports/SMI-2002-0929.pdf Guidelines S. W. Tu and M. A. Musen A flexible approach to guideline modeling, Proc AMIA Symp, pp. 420-4, 1999 Concepts consultation guidelines specify actions and decisions whose consequences are not being tracked over time management guidelines that model decisions and actions that lead to dependent changes in patient states over time Enrolment into a guideline automatic Manual Guidelines Interaction with a user None – complex reminders Some Frequent – walk-through approach Other views Foreground/background Reactive/proactive Active/passive Dimensions of a model Based on S. Tu paper: Flexible approach to guidelines modeling 1. Support provider behaviors that a guideline influences. (1) setting goals or constraints (2) choosing an alternative among competing options (3) sequencing a set of actions (4) interpreting data 2. Temporal dimensions of actions and data. one-shot decision making episodic interventions (e.g., outpatient encounter-