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Automating complex guidelines for chronic disease: lessons learned.

Saverio M Maviglia1, Rita D Zielstorff, Marilyn Paterno

  • 1Partners Healthcare System, Inc., 93 Worcester Street, PO Box 81905, Wellesley, MA 02481, USA. smaviglia@partners.org

Journal of the American Medical Informatics Association : JAMIA
|February 22, 2003
PubMed
Summary
This summary is machine-generated.

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Implementing complex computerized practice guidelines for chronic disease management is challenging. Workflow integration proved the most significant obstacle in our electronic medical record system.

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.

Related Experiment Videos

  • 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.