Making generic guidelines site-specific

Health care providers are more likely to follow a clinical guideline if the guideline's recommendations are consistent with the way in which their organization does its work. Unfortunately, developing guidelines that are specific to an organization is expensive, and limits the ability to share guidelines among different institutions. We describe a methodology that separates the site-independent information of guidelines from site-specific information, and that facilitates the development of site-specific guidelines from generic guidelines. We have used this methodology in a prototype system that assists developers in creating generic guidelines that are sharable across different sites. When combined with site information, generic guidelines can be used to generate site-specific guidelines that are responsive to organizational change and that can be implemented at a level of detail that makes site-specific computer-based workflow management and simulation possible.