Supporting physicians in the coordination of distributed execution of CIGs to treat comorbid patients

Clinical Practice Guidelines (CPGs) encode the "best" medical practices to treat patients affected by a specific disease and are widely used in the medical practice. Starting from the '90s', several Computer-Interpretable Guideline (CIG) systems have been devised to provide physicians with CPG-based decision support. CPGs (and CIGs) are devoted to provide evidence-based recommendations for one specific disease. In order to support the treatment of patients affected by multiple diseases (i.e., comorbid patients), challenging additional tasks have to be addressed, such as (i) the detection of the interactions between CIG actions, (ii) their management, and, finally, (iii) the "merge" or conciliation of the CIGs. Several CIG approaches have been recently extended in order to face (at least one of) such challenging problems, and one of them is GLARE. However, besides the solutions to tasks (i)-(iii) above, the "run-time" support to physicians treating a comorbid patient requires additional capabilities, to support the distribution of the management of interactions and of the execution of CIGs among different physicians. In this paper, we propose a general framework, based on GLARE and GLARE-SSCPM, to provide such additional capabilities.