Computer-interpretable clinical practice guidelines. Where are we and where are we going ?

Area of Science:

• Health Informatics
• Clinical Decision Support Systems
• Medical Informatics

Background:

• Computer-interpretable guideline (CIG) systems aim to automate the application of clinical practice guidelines.
• Previous efforts have focused on developing various CIG formalisms and their integration with healthcare systems.
• Understanding the current landscape of CIG systems and standardization is crucial for advancing their adoption.

Purpose of the Study:

• To provide a comprehensive overview of computer-interpretable guideline (CIG) systems for a non-expert audience.
• To review the history, features, and relationships of major CIG systems.
• To identify current standards development and future research needs in the CIG domain.

Main Methods:

• A literature review was conducted using PubMed and AMIA conference proceedings.
• Search terms included practice guidelines, decision support, controlled vocabulary, and medical record systems.
• Identified publications were reviewed and summarized narratively by both authors.

Main Results:

• Consensus exists that CIG systems must integrate with electronic health records (EHRs) for maximum effectiveness.
• Current CIG systems commonly use a task network model, but no single system dominates.
• A major challenge for CIG interoperability is the lack of a standard controlled vocabulary, though efforts like the Virtual Medical Record (VMR) concept are emerging.

Conclusions:

• CIG systems are currently in an evolutionary phase, with ongoing standards development expected to enhance interoperability.
• The Virtual Medical Record (VMR) concept offers a potential solution for bridging guideline vocabulary and EHR implementation.
• Future research should focus on improving guideline development processes and evaluation methods for CIG features.