An Object-Oriented Framework for the Development of Computer-Based Guideline Implementations

G.J Corb; Y. Liaw; C.A. Brandt; R.N. Shiffman

doi:10.1055/s-0038-1634190

Methods of Information in Medicine, Table of Contents

Methods Inf Med 1999; 38(03): 148-153
DOI: 10.1055/s-0038-1634190

Original Article

Schattauer GmbH

An Object-Oriented Framework for the Development of Computer-Based Guideline Implementations

G.J Corb

¹Center for Medical Informatics, USA

²Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut, USA

,

Y. Liaw

¹Center for Medical Informatics, USA

,

C.A. Brandt

¹Center for Medical Informatics, USA

,

R.N. Shiffman

¹Center for Medical Informatics, USA

²Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut, USA

› Author Affiliations

Abstract

Clinical practice guidelines provide a means of directing medical care towards clinically appropriate and cost-effective interventions. A direct relationship exists between the integration of a guideline into clinical workflow and the effectiveness of the guideline in influencing clinicians’ behavior. Computer-based guideline implementations, used at the point-of-care, accomplish this integration. Employing object-oriented technologies, we propose a framework of reusable components for the development of guideline implementation systems. We have identified eight information management services that are common to such systems. Our framework integrates these services and their respective reusable components into clinical workflow to promote the development of comprehensive guideline implementation systems, which should ultimately enhance guideline compliance and the overall quality of care.

Keywords

Object-Oriented Framework - Clinical Practice Guidelines - Software Engineering

Full Text

References

References
1 Coiera EW. Artificial intelligence in medicine: the challenges ahead. J Am Med Inform Assoc 1996; 3: 363-6.
2 Elson RB, Connelly DP. Computerized decision support systems in primary care. Primary Care 1995; 22: 365-84.
3 Shiffman RN, Liaw Y, Brandt CA, Corb GC. A design model for computer-based guideline implementation based on information management services. J Am Med Inform Assoc 1999; 6: 99-103.
4 Fayad ME, Schmidt DC. Object-oriented application frameworks. Communications of the ACM 1997; 40: 32-8.
5 Pree W. Design patterns for object-oriented software development. Wokingham, England: Addison-Wesley; 1995
6 Brugali D, Menga G, Aarsten A. The framework lifespan. Communications of the ACM 1997; 40: 65-8.
7 Shiffman RN, Liaw Y, Brandt CA, Corb GJ. Computer-based guideline implementation systems: a systematic review of functionality and effectiveness. J Am Med Inform Assoc 1999; 6: 104-14.
8 Shiffman RN. Representation of clinical practice guidelines in conventional and augmented decision tables. J Am Med Inform Assoc 1997; 4 (Suppl. 05) 382-93.
9 Hripcsak G, Clayton PD, Pryor TA. et al. The Arden syntax for medical logic modules. In: Miller RA. ed. Proceedings of the 14th Annual Symposium on Computer Applications in Medical Care . Washington, DC: IEEE Press; 1990: 200-4.
10 Ohno-Machado L, Gennari JH, Murphy SN. et al. The guideline interchange format: a model for representing guidelines. J Am Med Inform Assoc 1998; 5: 357-72.
11 Liaw Y, Shiffman RN. Challenges in hand-held guideline implementation. Spring Congress of the American Medical Informatics Association. Philadelphia Pa.; 1998
12 AAP Provisional Committee on Quality Improvement.. Practice parameter: the office management of acute exacerbations of asthma in children. Pediatrics 1994; 93: 119-26.
13 Shiffman RN, Freudigman KA, Liaw Y, Navedo D. A computer-based guideline implementation for asthma [Abstract #7]. Pediatric Academic Societies Annual Meeting. San Francisco, Calif.: 1999
14 National Institutes of Health.. Expert panel report 2: guidelines for the diagnosis and management of asthma. National Heart, Lung and Blood Institute, Publ No. 97-4051.
15 Shiffman RN, Greenes RA. Improving clinical guidelines with logic and decision table techniques: application to hepatitis immunization recommendations. Med Decis Making 1994; 14 (Suppl. 03) 245-54.
16 Shiffman RN, Liaw Y, Navedo DD, Freudigman KA. User satisfaction and frustration with a handheld, pen-based guideline implementation system for asthma. (to be publ.).