From clinical practice guidelines, to clinical guidance in practice--implications for design of computerized guidance

This paper presents a case study of clinical guidance within oncology clinics. Close to all patients treated within the observed clinics were treated according to a research or standard treatment protocol. The protocol artifacts were however rarely applied in clinical practice instead we found an extensive application of what we have named second order guiding artifacts. The deployed protocols underwent a local adaptation and transformation process when initiated. The protocols were adapted to match the local resources and transformed into several activity specific second order guiding artifacts. The transformation from protocols was executed according to a standard operating procedure. Each activity type had a standardized template ensuring uniformity across second order guiding artifacts within a clinic. The guiding artifacts were multi-functional and a wide variety of standardized graphical attributes were applied to support effortless appliance. The implications for computerization of clinical practice guidelines are discussed.