Lessons learned from adapting a generic narrative diabetic-foot guideline to an institutional decision-support system

Clinical guidelines usually need to be adapted to fit local practice before they can be actually used by clinicians. Reasons for adaptation include variations of institution setting such as type of practice and location, availability of resources, differences in patient populations, local policies, and practice patterns. When a guideline is implemented for clinical decision support and integrated with an institution's clinical information system, the data model of the local electronic medical record (EMR) and the data actually collected and stored in it also influence the guideline's adaptation. The purpose of this work is: (1) to characterize a tool-supported process for guideline encoding that addresses local adaptation and EMR integration, and (2) to identify the types of changes in guideline encoding during the local adaptation process.