International Journal of Medical Informatics
Volume 77, Issue 12 , Pages 787-808 , December 2008

Computer-based execution of clinical guidelines: A review

Received 31 October 2007 ,Revised 28 May 2008 ,Accepted 29 May 2008.

References 

  1. In:  Field M,  Lohr K editor. Clinical Practice Guidelines: Directions for a New Program, Institute of Medicine. Washington, DC: National Academy Press; 1990;
  2. Barahona P, Azevedo F, Veloso M, Estêvão N, Gallego R. Computerising a guideline for the management of diabetes. International Journal of Medical Informatics. 2001;64(2–3):275–284
  3. Elkin PL, Peleg M, Lacson R, Bernstam E, Tu SW, Boxwala A, et al. Toward standardization of electronic guideline representation. MD Computing. 2001;17:39–44
  4. Hart D. Risk management, clinical guidelines, clinical pathways and health law. European Journal of Health Law. 2003;10(3):219–222
  5. Lenz R, Blaser R, Beyer M, Heger O, Biber C, Bäumlein M, et al. IT support for clinical pathways—lessons learned. International Journal of Medical Informatics. 2007;76(S3):S397–S402
  6. Rutten F, Brouwer W, Niessen L. Practice guidelines based on clinical and economic evidence. Indispensable tools in future market oriented health care. European Journal of Health Economics. 2005;6:91–93
  7. ten Teije A, Marcos M, Balser M, van Croonenborg J, Duelli C, van Harmelen F, et al. Improving medical protocols by formal methods. Artificial Intelligence in Medicine. 2006;36:193–272
  8. Woolf SH, Grol R, Hutchinson A, Eccles M, Grimshaw J. Potential benefits, limitations, and harms of clinical guidelines. British Medical Journal. 1999;318:527–530
  9. Cabana MD, Rand CS, Powe NR, Wu AW, Wilson MH, Abboud P, et al. Why don’t physicians follow clinical practice guidelines? A framework for improvement. Journal of the American Medical Informatics Association. 1999;282:1458–1466
  10. Blaser R, Schnabel M, Biber C, Baumlein M, Heger O, Beyer M, et al. Improving pathway compliance and clinician performance by using information technology. International Journal of Medical Informatics. 2007;76:151–156
  11. de Clercq P, Blom J, Korsten H, Hasman A. Approaches for creating computer-interpretable guidelines that facilitate decision support. Artificial Intelligence in Medicine. 2004;31:1–27
  12. Fox J, Das S. Safe and Sound. AAAI and MIT Press; 2000;
  13. Peleg M, Tu S, Bury J, Ciccarese P, Fox J, Greenes RA, et al. Comparing computer-interpretable guideline models: a case-study approach. Journal of the American Medical Informatics Association. 2003;10:52–68
  14. Wang DA, Peleg M, Tu S, Shortliffe EH, Greenes RA. Representation of clinical practice guidelines. In:  Patel V,  Rogers R,  Haux R editor. Proceedings of 10th Triennial Congress of the International Medical Informatics Association (MEDINFO 2001), Vol. 84 of Studies in Health Technology and Informatics. London, UK. IOS Press; 2001;
  15. Davis D, Goldman J, Palda VA. Handbook on Clinical Practice Guidelines. Ottawa, CA: Canadian Medical Association; 2007;available on-line http://mdm.ca/cpgsnew/cpgs/index.asp (last visit October 10, 2007)
  16. Priori SG, Klein W, Bassand J. Medical practice guidelines: separating science from economics. European Heart Journal. 2003;24(21):1962–1964
  17. Riaño D. Ordered time-independent CIG learning. In:  Barreiro JM,  Martín-Sánchez F,  Maojo V,  Sanz F editor. Proceedings of V International Symposium on Biological and Medical Data Analysis (ISBMDA 2004), Vol. 3337 of Lecture Notes on Computer Science. Barcelona, Catalonia. Springer-Verlag; 2004;p. 117–128
  18. Hrabak KM, Campbell JR, Tu SW, McClure R, Weida R. Creating interoperable guidelines: requirements of vocabulary standards in immunization decision support. In:  Kuhn KA,  Warren JR,  Leong T-Y editor. Proceedings of the 12th World Congress on Health (Medical) Informatics (MEDINFO 2007), Vol. 129. Brisbane, Australia. IOS Press; 2007;p. 930–934
  19. The AGREE Collaboration . Development and validation of an international appraisal instrument for assessing the quality of clinical practice guidelines: the AGREE project. Quality and Safety in Health Care. 2003;12(1):18–23
  20. Ricci S, Celani MG, Righetti E. Development of clinical guidelines: methodological and practical issues. Neurological Sciences. 2006;27:228–230
  21. Chesani F, Matteis PD, Mello P, Montal M, Storari S. A framework for defining and verifying clinical guidelines: a case study on cancer screening. In:  Esposito F,  Ras ZW,  Malerba D,  Semeraro G editor. Proceedings of 16th International Symposium (ISMIS 2006), Vol. 4203 of Lecture Notes on Artificial Intelligence. Bari, Italy. Berlin, Heidelberg: Springer; 2006;p. 338–343
  22. Leong T-Y, Kaiser K, Miksch S. Free and open source enabling technologies for patient-centric, guideline-based clinical decision support: a survey, IMIA yearbook of medical informatics. Methods of Information in Medicine. 2007;46:74–86
  23. Seyfang A, Miksch S, Marcos M, Wittenberg J, Polo-Conde C, Rosenbrand K. Bridging the gap between informal and formal guideline representations. In:  Brewka G,  Coradeschi S,  Perini A,  Traverso P editor. Proceedings of 17th European Conference on Artificial Intelligence (ECAI 2006). Riva del Garda, Italy. IOS Press; 2006;p. 447–451
  24. Coiera E. Guide to Health Informatics. Hodder Arnold; 2003;
  25. Georgiou A, Williamson M, Westbrook JI, Ray S. The impact of computerised physician order entry systems on pathology services: a systematic review. International Journal of Medical Informatics. 2007;76:514–529
  26. Hripcsak G, Clayton PD, Jenders RA, Cimino JJ, Johnson SB. Design of a clinical event monitor. Computers and Biomedical Research. 1996;29(3):194–221
  27. Shiffman RN, Liaw Y, Brandt CA, Corb GJ. Computer-based guideline implementation systems: a systematic review of functionality and effectiveness. Journal of the American Medical Informatics Association. 1999;6(2):104–114
  28. Fox J, Alabassi A, Patkar V, Rose T, Black E. An ontological approach to modelling tasks and goals. Computers in Biology and Medicine. 2006;36:837–856
  29. Fox J, Beveridge M, Glasspool D. Understanding intelligent agents: analysis and synthesis. AI Communications. 2003;16:139–152
  30. Sutton DR, Fox J. The syntax and semantics of the PROforma guideline modeling language. Journal of the American Medical Informatics Association. 2003;10:433–443
  31. InferMed, Arezzo Technical White Paper, Tech. rep., InferMed, Ltd., available on-line http://www.infermed.com/ (last visit October 10, 2007), 2007.
  32. Shahar Y, Young O, Shalom E, Galperin M, Mayaffit A, Moskovitch R, et al. A framework for a distributed, hybrid, multiple-ontology clinical-guideline library and automated guideline-support tools. Journal of Biomedical Informatics. 2004;37(5):325–344
  33. Young O, Shahar Y, Liel Y, Lunenfeld E, Bar G, Shalom E, et al. Runtime application of Hybrid-Asbru clinical guidelines. Journal of Biomedical Informatics. 2007;40:507–526
  34. Miksch S, Shahar Y, Johnson P. Asbru: a task-specific, intention-based, and time-oriented language for representing skeletal plans. In:  Motta E,  van Harmelen F,  Pierret-Golbreich C,  Filby I,  Wijngaards N editor. Proceedings of Seventh Workshop on Knowledge Engineering: Methods and Languages (KEML 1997). UK: Milton Keynes; 1997;
  35. Advani A, Shahar Y, Musen MA. Medical quality assessment by scoring adherence to guideline intentions. Journal of the American Medical Informatics Association. 2003;9:92–97
  36. Young O, Shahar Y. The spock system: developing a runtime application engine for hybrid-Asbru guidelines. In:  Miksch S,  Hunter J,  Keravnou E editor. Proceedings of 10th Conference on Artificial Intelligence in Medicine (AIME 2005), Vol. 3581 of Lecture Notes on Artificial Intelligence. Aberdeen, Scotland. Springer-Verlag; 2005;p. 166–170
  37. Anselma L, Terenziani P, Montani S, Bottrighi A. Towards a comprehensive treatment of repetitions, periodicity and temporal constraints in clinical guidelines. Artificial Intelligence in Medicine. 2006;38:171–195
  38. Terenziani P, Montani S, Bottrighi A, Molino G, Torchio M. Clinical guidelines adaptation: managing authoring and versioning issues. In:  Miksch S,  Hunter J,  Keravnou E editor. Proceedings of 10th Conference on Artificial Intelligence in Medicine (AIME 2005), Vol. 3581 of Lecture Notes on Artificial Intelligence. Aberdeen, Scotland. Springer-Verlag; 2005;p. 151–155
  39. Terenziani P, Montani S, Bottrighi A, Torchio M, Molino G, Correndo G. The GLARE approach to clinical guidelines: main features. In:  Kaiser K,  Miksch S,  Tu S editor. Computer-based Support for Clinical Guidelines and Protocols. Proceedings of the Symposium on Computerized Guidelines and Protocols (CGP 2004), Vol. 101 of Studies in Health Technology and Informatics. Prague, Czech Republic. IOS Press; 2004;p. 162–166
  40. Terenziani P, Montani S, Bottrighi A, Torchio M, Molino G, Anselma L, et al. Applying artificial intelligence to clinical guidelines: the GLARE approach. In:  Cappelli A,  Turini F editor. Proceedings of Eighth Congress of the Italian Association for Artificial Intelligence (AI*IA 2003), Vol. 2829 of Lecture Notes in Computer Science. Pisa, Italy. Heidelberg: Springer-Verlag; 2003;p. 536–547
  41. Terenziani P, Molino G, Torchio M. A modular approach for representing and executing clinical guidelines. Artificial Intelligence in Medicine. 2001;23:249–276
  42. Anselma L, Terenziani P, Montani S, Bottrighi A. Automatic checking of the correctness of clinical guidelines in GLARE. In:  Kuhn KA,  Warren JR,  Leong T-Y editor. Proceedings of the 12th World Congress on Health (Medical) Informatics (MEDINFO 2007), Vol. 129 of Studies in Health Technology and Informatics. Brisbane, Australia. IOS Press; 2007;p. 807–811
  43. Terenziani P, Carlini C, Montani S. Towards a comprehensive treatment of temporal constraints in clinical guidelines. In: Proceedings of Ninth International Symposium on Temporal Representation and Reasoning (TIME 2002). Manchester, UK. IEEE Press; 2002;p. 20–27
  44. Wang D, Peleg M, Tu SW, Boxwala AA, Ogunyemi O, Zeng Q, et al. Design and implementation of the GLIF3 guideline execution engine. Journal of Biomedical Informatics. 2004;37:305–318
  45. Wang D, Shortliffe EH. GLEE—a model-driven execution system for computer-based implementation of clinical practice guidelines. In: Proceedings of American Medical Informatics Association Annual Symposium (AMIA 2002). San Antonio, USA. American Medical Informatics Association (AMIA); 2002;p. 855–859
  46. Choi J, Currie LM, Wang D, Bakken S. Encoding a clinical practice guideline using guideline interchange format: a case study of a depression screening and management guideline. International Journal of Medical Informatics. 2007;76S:S302–S307
  47. Boxwala AA, Peleg M, Tu SW, Ogunyemi O, Zeng Q, Wang D, et al. GLIF3: a representation format for sharable computer-interpretable clinical practice guidelines. Journal of Biomedical Informatics. 2004;37:147–161
  48. Wang D, Peleg M, Bu D, Cantor M, Landesberg G, Lunenfeld E, et al. GESDOR—a generic execution model for sharing of computer-interpretable clinical practice guidelines. In:  Musen M editors. Proceedings of American Medical Informatics Association Annual Symposium (AMIA 2003). Ottawa, Canada. American Medical Informatics Association (AMIA); 2003;p. 694–698
  49. D. Wang, A generic execution model for sharing of computer-interpretable clinical practice guidelines, PhD thesis, Columbia University, USA, 2003.
  50. Wooldridge M. An Introduction to Multiagent Systems. West Sussex, England: John Wiley and Sons, Ltd.; 2002;
  51. Isern D, Moreno A. Agent-based careflow using CPGs. In:  Vitrià J,  Radeva P,  Aguiló I editor. Recent Advances in Artificial Intelligence Research and Development, Vol. 113 of Frontiers in Artificial Intelligence and Applications. IOS Press; 2004;p. 11–18
  52. Isern D, Moreno A. Distributed guideline-based health care system. In: Proceedings of Fourth International Conference on Intelligent Systems Design and Applications (ISDA 2004). Budapest, Hungary. IEEE Press; 2004;p. 145–150
  53. Isern D, Valls A, Moreno A. Using aggregation operators to personalize agent-based medical services. In: Proceedings (Part II) of 10th International Conference on Knowledge-based and Intelligent Information and Engineering Systems (KES 2006), Vol. 4252 of Lecture Notes on Artificial Intelligence. Berlin, Heidelberg: Springer; 2006;p. 1256–1263
  54. Isern D, Sánchez D, Moreno A. An ontology-driven agent-based clinical guideline execution engine. In: Proceedings of 10th International Conference on Artificial Intelligence in Medicine (AIME 2007), Vol. 4594 of Lecture Notes on Artificial Intelligence. Berlin, Heidelberg: Springer; 2007;p. 49–53
  55. Lau LM, Shakib S. Towards data interoperability: practical issues in terminology implementation and mapping. In: Proceedings of 13th National Health Informatics Conference (HIC 2005). Melbourne, Australia. Health Informatics Society of Australia; 2005;p. 208–213
  56. Isern D, Sánchez D, Moreno A. HeCaSe2: a multi-agent ontology-driven guideline enactment engine. In: Proceedings of Multi-agent Systems and Applications V. Proceedings of Fifth International Central and Eastern European Conference on Multi-agent Systems (CEEMAS 2007), Vol. 4696 of Lecture Notes on Artificial Intelligence. Berlin, Heidelberg: Springer; 2007;p. 322–324
  57. Moreno A, Isern D, Sánchez D. Provision of agent-based health care services. AI Communications. 2003;16:167–178
  58. Moreno A, Sánchez D, Isern D. Security measures in a medical multi-agent system. In:  Aguiló I,  Valverde L,  Escrig M editor. Artificial Intelligence Research and Development, Vol. 100 of Frontiers in Artificial Intelligence and Applications. Amsterdam, The Netherlands: IOS Press; 2003;p. 244–255
  59. Ciccarese P, Caffi E, Boiocchi L, Quaglini S, Stefanelli M. A guideline management system. In:  Fieschi M,  Coiera E,  Li Y-C editor. Proceedings of 11th World Congress of the International Medical Informatics Association (MEDINFO 2004), Vol. 107 of Studies in Health Technology and Informatics. San Francisco, USA. IOS Press; 2004;p. 28–32
  60. Ciccarese P, Caffi E, Quaglini S, Stefanelli M. Architectures and tools for innovative health information systems: the guide project. International Journal of Medical Informatics. 2005;74:553–562
  61. Quaglini S, Stefanelli M, Cavallini A, Micieli G, Fassino C, Mossa C. Guideline-based careflow systems. Artificial Intelligence in Medicine. 2000;20:5–22
  62. Quaglini S, Stefanelli M, Lanzola G, Caporusso V, Panzarasa S. Flexible guideline-based patient careflow systems. Artificial Intelligence in Medicine. 2001;22:65–80
  63. Kumar A, Quaglini S, Stefanelli M, Ciccarese P, Caffi E, Boiocchi L. A framework for representing and executing a clinical practice guideline for the management of high blood pressure in pregnancy. Technology and Health Care. 2002;10:517–519
  64. Quaglini S, Ciccarese P, Micieli G, Cavallini A. Non-compliance with guidelines: motivations and consequences in a case study. In:  Kaiser K,  Miksch S,  Tu S editor. Proceedings of Symposium on Computerized Guidelines and Protocols (CGP 2004), Vol. 101 of Studies in Health Technology and Informatics. Prague, Czech Republic. IOS Press; 2004;p. 75–87
  65. Berg D, Ram P, Glasgow J. SAGEDesktop: an environment for testing clinical practice guidelines. In: Proceedings of 26th Annual Conference of the IEEE Engineering in Medicine and Biology Society (IEBMS 2004), Vol. 2. San Francisco, USA. IEEE Press; 2004;p. 3217–3220
  66. Tu SW, Hrabak KM, Campbell JR, Glasgow J, Nyman MA, McClure R, et al. Use of declarative statements in creating and maintaining computer-interpretable knowledge bases for guideline-based care. In: Proceedings of American Medical Informatics Association Annual Symposium (AMIA 2006). Washington, DC, USA. American Medical Informatics Association (AMIA); 2006;p. 784–788
  67. Tu SW, Campbell J, Musen MA. SAGE guideline modeling: motivation and methodology. In:  Kaiser K,  Miksch S,  Tu S editor. Proceedings of Symposium on Computerized Guidelines and Protocols (CGP 2004), Vol. 101 of Studies in Health Technology and Informatics. Prague, Czech Republic. IOS Press; 2004;p. 167–171
  68. Tu SW, Campbell JR, Glasgow J, Nyman MA, McClure R, McClay J, et al. The SAGE guideline model: achievements and overview. Journal of the American Medical Informatics Association. 2007;14(5):589–598
  69. Gennari JH, Musen MA, Fergerson RW, Grosso WE, Crubézy M, Eriksson H, et al. The evolution of Protégé: an environment for knowledge-based systems development. International Journal of Human-Computer Studies. 2003;58(1):89–123
  70. Tu S, Musen M. Modeling data and knowledge in the EON guideline architecture. In:  Patel V,  Rogers R,  Haux R editor. Proceedings of 10th Triennial Congress of the International Medical Informatics Association (MEDINFO 2001), Vol. 84 of Studies in Health Technology and Informatics. London, UK. IOS Press; 2001;p. 280–284
  71. Ram P, Berg D, Tu SW, Mansfield JG, Ye Q, Abarbanel RM. Executing clinical practice guidelines using the SAGE execution engine. In:  Fieschi M,  Coiera E,  Li Y-CJ editor. Proceedings of Congress of the International Medical Informatics Association (MEDINFO 2004), Vol. 107 of Studies in Health Technology and Informatics. San Francisco, USA. IOS Press; 2004;p. 251–255
  72. McClure R, Campbell J, Nyman M, Glasgow J. Guidelines and standard terminology: making standard terminology work in clinical guidelines. In: Proceedings of 78th Annual American Health Information Management Association Conference (AHIMA 2006). Denver, USA. AHIMA Press; 2006;p. 481–491
  73. K. Dube, A Generic approach to supporting the management of computerised clinical guidelines and protocols, PhD thesis, Institute of Technology, Dublin, Ireland, 2004.
  74. Dube K, Mansour E, Wu B. Supporting collaboration and information sharing in computer-based clinical guideline management. In: Proceedings of 18th IEEE Symposium on Computer-based Medical Systems (CBMS 2005). Dublin, Ireland. IEEE Press; 2005;p. 232–237
  75. Dube K, Wu B. An active database approach to computerised clinical guideline management. In:  Cordeiro J,  Filipe J editor. Computer Supported Activity Coordination, Proceedings of the Third International Workshop on Computer Supported Activity Coordination (CSAC 2006). Paphos, Cyprus. INSTICC Press; 2006;p. 107–115
  76. Mansour E, Wu B, Dube K, Li JX. An event-driven approach to computerizing clinical guidelines using XML. In: Proceedings of the IEEE Services Computing Workshops (SCW 2006). Chicago, USA. IEEE Computer Society; 2006;p. 13–20
  77. Quaglini S, Ciccarese P. Models for guideline representation. Neurological Sciences. 2006;S3:240–244
  78. Peleg M, Tu SW. Decision support, knowledge representation and management in medicine. In:  Haux R,  Kulikowski C editor. International Medical Informatics Association (IMIA) Yearbook of Medical Informatics 2006. Germany: International Medical Informatics Association, Schattauer GmbH; 2006;
  79. Stefanelli M. Knowledge and process management in health care organizations. Methods of Information in Medicine. 2004;43(5):525–535
  80. Bates DW, Kuperman GJ, Wang S, Gandhi T, Kittler A, Volk L, et al. Ten commandments for effective clinical decision support: making the practice of evidence-based medicine a reality. Journal of the American Medical Informatics Association. 2003;10:523–530
  81. Lenz R, Reichert M. IT support for healthcare processes. In:  van der Aalst WM,  Benatallah B,  Casati F,  Curbera F editor. Proceedings of Third International Conference (BPM 2005), Vol. 3649 of Lecture Notes in Computer Science. Nancy, France. Berlin, Heidelberg: Springer; 2005;p. 354–363
  82. Shiffman RN, Michel G, Essaihi A, Thornquist E. Bridging the guideline implementation gap: a systematic, document-centered approach to guideline implementation. Journal of the American Medical Informatics Association. 2004;11:418–427
  83. Boxwala AA, Tu S, Peleg M, Zeng Q, Ogunyemi O, Greenes RA, et al. Toward a representation format for sharable clinical guidelines. Journal of Biomedical Informatics. 2001;34:157–169
  84. Peleg M, Boxwala AA, Tu S, Zeng Q, Ogunyemi O, Wang D, et al. The InterMed approach to sharable computer-interpretable guidelines: motivations and lessons. Journal of the American Medical Informatics Association. 2004;11:1–10
  85. Jennings NR. Coordination techniques for distributed artificial intelligence. In:  O’Hare GMP,  Jennings NR editor. Foundations of Distributed Artificial Intelligence, John Wiley Sixth-generation Computer Technology Series. New York, NY, USA: John Wiley and Sons, Inc.; 1996;p. 187–210
  86. Holbrook A, Keshavjee K, Troyan S, Pray M, Ford PT. Applying methodology to electronic medical record selection. International Journal of Medical Informatics. 2003;71:43–50
  87. Coiera E. Healthcare terminologies and classification systems. In: Guide to Health Informatics. Hodder Arnold; 2003;p. 201–216
  88. Peleg M, Keren S, Denekamp Y. Mapping computerized clinical guidelines to electronic medical records: knowledge-data ontological mapper (KDOM). Journal of Biomedical Informatics. 2008;41(1):180–201
  89. NCQHC, CEO Survival Guide, Electronic Health Record Systems, National Committee for Quality Health Care, Washington, DC, USA, 2006, available at http://www.nqfexecutiveinstitute.org/executiveinstitute/EHRbookfinal.pdf (last visit January 30, 2008).
  90. Müller ML, Ganslandt T, Eich HP, Lang K, Ohmann C, Prokosch H-U. Towards integration of clinical decision support in commercial hospital information systems using distributed, reusable software and knowledge components. International Journal of Medical Informatics. 2001;64(2–3):369–377
  91. Schadow G, Russler DC, McDonald CJ. Conceptual alignment of electronic health record data with guideline and workflow knowledge. International Journal of Medical Informatics. 2001;64(2–3):259–274
  92. Veselý A, Zvárová J, Peleska J, Buchtela D, Anger Z. Medical guidelines presentation and comparing with electronic health record. International Journal of Medical Informatics. 2006;75(3–4):240–245
  93. Fischer-Hübner S. IT-Security and Privacy. Design and Use of Privacy Enhancing Security Mechanisms, Vol. 1958 of Lecture Notes in Computer Science. Berlin, Heidelberg: Springer; 2001;
  94. Schreiber G, Akkermans H, Anjewierden A, de Hoog R, Shadbolt N, van der Velde W, et al. Knowledge Engineering and Management: The CommonKADS Methodology. MIT Press; 1999;

PII: S1386-5056(08)00084-1

doi: 10.1016/j.ijmedinf.2008.05.010

International Journal of Medical Informatics
Volume 77, Issue 12 , Pages 787-808 , December 2008

Article Tools

* Image Usage & Resolution