An architecture for a distributed guideline server

A number of barriers exist which prevent the widespread integration of practice guidelines with electronic medical record systems. These include dependencies on clinical databases, as well as problems with converting existing guideline specifications into computable rules. We are developing the MBTA (Modeling Better Treatment Advice) practice guideline system which uses a distributed client-server architecture and an object-oriented data representation to support practice guidelines usable by different electronic medical record systems. We describe the structure and organization of MBTA, focusing on how an open systems design, combined with principles of guideline implementation, can be used to provide a general purpose guideline server for use by a variety of clinical workstations.