Computer-Mediated Guideline Implementation Projects
Overview
AsthMonitor
Information Management Services Model
PalmAsthma
Object-Oriented Framework
Guideline Elements Model (GEM)
Publications
A major, world-wide initiative is devoted to the development and dissemination of clinical practice guidelines to define and promote "best clinical practices" based on research findings and to diminish inappropriate variation. As defined by the Institute of Medicine, guidelines are "systematically developed statements to assist practitioner and patient decisions about appropriate health care for specific clinical circumstances." Thousands of guidelines have been developed, but merely publishing them often does not influence clinicians' behavior. Computer-based, clinical decision support systems that incorporate knowledge from evidence-based guidelines hold great promise for influencing medical care.
A major obstacle to the use of computers in medicine has been the fact that clinicians are mobile knowledge workers, while computers are often desk-bound. In addition, many physicians are resistant to keyboard-based data entry. Effective decision support systems must be integrated with clinical workflow and provide a net benefit to offset the inconveniences associated with computer use.
Over the past several years, our group at the YCMI has explored the use of mobile, pen-based devices that incorporate guideline knowledge to provide clinical decision support and overcome challenges to user acceptance.