Conceptual integration of guidelines and workflow into the electronic health record

Even though computerized practice guidelines and workflow management (WfM) are proven effective techniques to improving quality of care and reducing costs, they are not widely deployed today. One reason for this is the impedance mismatch between guideline systems and electronic heath record (EHR) systems. This paper presents the Unified Service Action Model (USAM) that has been developed for the HL7 Reference Information Model and that conceptually integrates guidelines and workflow management into the EHR. We argue that the information items recorded in the EHR are logically similar to guideline and WfM definition. Therefore, guidelines and EHR reuse the same information structure in the USAM. This reuse is possible through a technique borrowed from natural language grammar and modal logic. The conceptual alignment of guidelines, WfM and the EHR could facilitate the sharing and deployment of guidelines in routine health care.