Development of a guideline-based decision support system with explanation facilities for outpatient therapy

For effective guideline implementation it is recommended to develop and apply carefully designed implementation strategies and instruments. Computerized decision support systems (CDSSs) are such instruments as they can improve guideline adherence by providing advice at the point of care. To improve the implementation of the Dutch cardiac rehabilitation guidelines a CDSS, named CARDSS, was developed. CARDSS actively provides care professionals with patient-specific, guideline-based treatment recommendations at the onset of a patient's rehabilitation trajectory. To maximize the chances of acceptance, CARDSS also provides explanation facilities and other additional information management services, and takes the working procedures specific to multidisciplinary outpatient care into account. CARDSS is currently used in over 40 Dutch cardiac rehabilitation outpatient clinics. This paper describes the development of the CARDSS system. In particular, technical issues are discussed concerning the delivery of active decision support, and the provision of advice rationales to users while taking account of dynamic clinical contexts and changing guidelines.