The electronic medical record: decision support and the effective use of clinical guidelines

Embedding clinical guidelines into an electronic medical record is a form of clinical decision support that has the potential to improve the quality and consistency of care provided at the clinical encounter. The manuscript describes the consensus method of developing clinical guidelines and its components that have an impact on its output. These include questions asked, participants, the presentation of information, method of structuring group interaction, and method of synthesizing judgments. Clinicians need to be aware of how these elements can affect guideline development. The quality of research on guideline development is varied. The process of guideline development is poorly documented, not evidence-based, and lacks the transparency that allows users to judge the output and quality of local adherence. The manner in which the presentation of guidelines is structured and implemented is also important in determining adherence. Monitoring guidelines by building a feedback loop is critical for ongoing guideline improvement. The literature on the long-term impact of electronic guidelines on clinician behavior is lacking.