Online Practice Guidelines
Issues, Obstacles, and Future Prospects
- Correspondence and reprints: Rita D. Zielstorff, RN, MS, Clinical Information Systems Research and Development, Partners Information Systems, 850 Boylston St., Suite 202, Brookline, MA 02167. e-mail: 〈rzielsto{at}warren.med.harvard.edu〉
- Received 12 November 1997
- Accepted 12 January 1998
Abstract
The “guidelines movement” was formed to reduce variability in practice, control costs, and improve patient care outcomes. Yet the overall impact on practice and outcomes has been disappointing. Evidence demonstrates that the most effective method of stimulating awareness of and compliance with best practices is computer-generated reminders provided at the point of care. This paper reviews five steps along the path from the development of a guideline to its integration into practice and the subsequent evaluation of its impact on practice and outcomes. Issues arising at each step and obstacles to moving from one step to the next are described. Last, developments that could help overcome the obstacles are highlighted. These include 1) more rapid knowledge acquisition using data mining, 2) better accommodation to imprecise knowledge in clinical algorithms using fuzzy logic, 3) development of a shareable model for guideline representation and execution, and 4) more widespread availability of clinically robust information systems that support decision-making at the point of care.
Footnotes
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This paper was presented at the International Medical Informatics Association (IMIA) Nursing Informatics `97 Working Conference, “Informatics and Patient and Clinical Guidelines: The State of Our Knowledge and a Vision,” Stockholm, Sweden, October 2-4, 1997.
