Comprehensive categorization of guideline recommendations: creating an action palette for implementers

Transforming guideline recommendations into executable statements for computerized decision support systems requires a clear understanding of what tasks must be performed. We sought (a) to determine whether a limited set of action types could be defined to comprehensively categorize activities recommended by the majority of clinical guidelines, (b) to describe the relative frequency of these action types, and (c) to create a library of recommendations for future validation activities. We randomly selected test and validation sets of 50 recommendations each from the National Guideline Clearinghouse and randomly extracted 3 recommendations from each guideline. We tested the ability of a preliminary palette of action types to categorize guideline-prescribed activities and expanded it to accommodate several unanticipated actions. Ultimately, the following actions were sufficient to categorize all 405 actions: Prescribe, Perform therapeutic procedure, Educate/Counsel, Test, Dispose, Refer/Consult, Conclude, Monitor, Document, Advocate, Prepare, and No recommendation., and Prepare. Thus, we define a set of terms that can facilitate guideline implementation in clinical information systems. These action types can be used to construct a framework for design of clinical decision support systems.