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Automating Complex Guidelines for Chronic Disease: Lessons Learned

Affiliations of the authors: Partners Healthcare System, Inc., Chestnut Hill, Massachusetts; Division of General Internal Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts (SMM, DWB); Healthvision, Inc., Waltham, Massachusetts (RDZ); Partners Healthcare System, Inc., Chestnut Hill, Massachusetts (MP); Department of Emergency Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts; Healthvision, Inc., Waltham, Massachusetts (JMT); Partners Healthcare System, Inc., Chestnut Hill, Massachusetts, and Harvard Medical School, Boston, Massachusetts (GJK).

Correspondence and reprints: Saverio M. Maviglia, MD, Partners HealthCare System, Inc., 93 Worcester Street, P.O. Box 81905, Wellesley, MA 02481; e-mail: <smaviglia{at}partners.org>.

There is scant published experience with implementing complex, multistep computerized practice guidelines for the long-term management of chronic diseases. We have implemented a system for creating, maintaining, and navigating computer-based clinical algorithms integrated with our electronic medical record. This article describes our progress and reports on lessons learned that might guide future work in this field. We discuss issues and obstacles related to choosing and adapting a guideline for electronic implementation, representing and executing the guideline as a computerized algorithm, and integrating it into the clinical workflow of outpatient care. Although obstacles were encountered at each of these steps, the most difficult were related to workflow integration.

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