From Clinical Practice Guidelines to Computer-interpretable Guidelines A Literature Overview

Background Guidelines are among us for over 30 years Initially they were used as algorithmic protocols by nurses and other ancillary personnel Many physicians regarded the use of guidelines as cookbook medicine However, quality and patient safety issues have, changed the attitude towards guidelines Implementing formalized guidelines in a decision support system with an interface to an electronic patient record (EPR) makes the application of guidelines more personal and therefore acceptable at the moment of care Objective To obtain via a literature review an insight into factors that influence the de sign and implementation of guidelines Methods An extensive search of the scientific literature in PubMed was carried out with a focus on guideline characteristics, guideline 1 development and implementation, and guide line dissemination Results We present studies that enable us ' to explain the characteristics of high quality guidelines and new advanced methods for guideline formalization computerization and implementation We show how the guidelines affect processes of care and the patient out come We discuss the reasons of low guideline adherence as presented in the literature and comment upon them Conclusions Developing high quality guide lines requires a skilled team of people and sufficient budget The guidelines should give personalized advice Computer interpretable guidelines (CIGs) that have access to the patient s EPR are able to give personal advice Because of the costs, sharing of CIGs is a critical requirement for guideline development dissemination and implementation Until now this is hardly possible, because of the many models in use However some solutions have been proposed For instance a standardized terminology should be imposed so that the terms in guidelines can be matched with terms in an EPR Also a dissemination model for easy updating of guidelines should be established The recommendations should be based on evidence instead of on consensus To test the quality of the guideline, appraisal instruments should be used to assess the guide line as a whole as well as checking the quality of the recommendations individually Only in this way optimal guideline advice can be given on an individual basis at a reasonable cost