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The challenges of automating a real-time clinical practice guideline
Y Sun1, F J van Wingerde, I S Kohane
1Joint Program in Neonatology, Harvard Medical School, Boston, MA, USA.
Insights
Implementing web-based clinical practice guidelines for newborn hyperbilirubinemia management revealed challenges. Guideline modifications and workflow integration were crucial for successful adoption in clinical settings.
Area of Science:
- Medical Informatics
- Pediatric Healthcare
- Clinical Guideline Development
Background:
- Clinical practice guidelines are essential for standardizing care.
- Implementing guidelines into digital formats presents unique challenges.
- Hyperbilirubinemia in newborn infants requires careful management based on established guidelines.
Purpose of the Study:
- To identify problems encountered when implementing a World Wide Web-based clinical practice guideline for managing hyperbilirubinemia in newborns.
- To assess the feasibility and challenges of automating clinical guidelines for pediatric care.
Main Methods:
- A formative assessment was conducted on an automated clinical practice guideline.
- Implementation occurred across primary care, inpatient, and emergency departments of a children's hospital.
- Participants included pediatricians, neonatologists, nurses, and computer scientists.
Main Results:
- Direct translation of existing hyperbilirubinemia guidelines to web pages was not feasible.
- Modifications to guidelines were necessary for accurate clinical intent representation.
- Automated guideline required enhancements for clinical workflow integration, including encounter form generation.
- Computer resource limitations and time constraints during patient encounters influenced the final design.
Conclusions:
- Many clinical guidelines require significant adaptation for automated systems.
- Successful implementation necessitates guideline modification and integration with clinical workflows.
- Iterative development and pilot testing are vital to address clinical use constraints.
Objective:
To elucidate the types of problems encountered during implementation of a World Wide Web-based clinical practice guideline to manage hyperbilirubinemia in newborn infants.
Design:
Formative assessment of an automated clinical-practice guideline in a large-scale implementation.
Setting:
Primary-care clinics and offices, inpatient clinics, and emergency department affiliated with an academic children's hospital.
Participants:
General pediatricians, neonatologists, pediatric nurses, and computer scientists.
Results:
Existing guidelines for hyperbilirubinemia management could not be translated directly into web pages. Modifications of the original guidelines were required to represent the clinical intent of the guidelines accurately. In addition, the automated guideline was augmented to incorporate a mechanism for generating clinical encounter forms in order for the system to be accepted into the clinical work flow. Other clinical considerations that influenced the final form of the automated guideline included limitations of computer resources and time constraints during patient encounters.
Conclusions:
Many existing guidelines are not amenable to straightforward implementation in automated systems. Strategies to increase the efficacy of the automated guidelines included guideline modifications, as well as careful consideration of the flow of clinical work. Repeated cycles of development and pilot testing are needed to design methods to accommodate the constraints imposed by clinical use.
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