Automating complex guidelines for chronic disease: lessons learned

Area of Science:

• Health Informatics
• Clinical Decision Support Systems
• Medical Practice Guidelines

Background:

• Limited published experience exists for complex, multistep computerized practice guidelines in chronic disease management.
• Electronic health records (EHRs) offer potential for integrating clinical guidelines.
• Successful implementation requires addressing guideline adaptation, algorithmic representation, and clinical workflow.

Purpose of the Study:

• To describe the implementation of a system for creating, maintaining, and navigating computer-based clinical algorithms.
• To report on lessons learned from implementing computerized practice guidelines in an EHR system.
• To identify challenges and guide future work in electronic guideline implementation.

Main Methods:

• Development of a system for computer-based clinical algorithms.
• Integration of algorithms with an existing electronic medical record system.
• Evaluation of challenges in guideline selection, adaptation, algorithmic representation, and workflow integration.

Main Results:

• A system for computer-based clinical algorithms was successfully implemented and integrated with an EHR.
• Obstacles were encountered throughout the implementation process.
• Workflow integration presented the most significant challenges.

Conclusions:

• Implementing complex computerized practice guidelines into clinical workflows is feasible but challenging.
• Workflow integration is a critical factor for successful adoption of electronic guidelines.
• Lessons learned can inform future efforts to integrate clinical decision support into routine care.