This Article Full Text Full Text (PDF) Submit a response Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Zielstorff, R. D. Search for Related Content PubMed PubMed Citation Articles by Zielstorff, R. D.

Online Practice Guidelines

Issues, Obstacles, and Future Prospects

Affiliation of the author: Partners HealthCare System, Boston, Massachusetts.

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>.

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.

This article has been cited by other articles:

				G. J. Kuperman, R. M. Reichley, and T. C. Bailey Using Commercial Knowledge Bases for Clinical Decision Support: Opportunities, Hurdles, and Recommendations J. Am. Med. Inform. Assoc., July 1, 2006; 13(4): 369 - 371. [Full Text] [PDF]

				E. Rood, R. J. Bosman, J. I. van der Spoel, P. Taylor, and D. F. Zandstra Use of a Computerized Guideline for Glucose Regulation in the Intensive Care Unit Improved Both Guideline Adherence and Glucose Regulation J. Am. Med. Inform. Assoc., March 1, 2005; 12(2): 172 - 180. [Abstract] [Full Text] [PDF]

				M. M. Kuilboer, M. A. M. van Wijk, M. Mosseveld, and J. van der Lei AsthmaCritic: Issues in Designing a Noninquisitive Critiquing System for Daily Practice J. Am. Med. Inform. Assoc., September 1, 2003; 10(5): 419 - 424. [Abstract] [Full Text] [PDF]

				S. M. Maviglia, R. D. Zielstorff, M. Paterno, J. M. Teich, D. W. Bates, and G. J. Kuperman Automating Complex Guidelines for Chronic Disease: Lessons Learned J. Am. Med. Inform. Assoc., March 1, 2003; 10(2): 154 - 165. [Abstract] [Full Text] [PDF]

				R. N. Shiffman, B. T. Karras, A. Agrawal, R. Chen, L. Marenco, and S. Nath GEM: A Proposal for a More Comprehensive Guideline Document Model Using XML J. Am. Med. Inform. Assoc., September 1, 2000; 7(5): 488 - 498. [Abstract] [Full Text]

				A. H. Morris Developing and Implementing Computerized Protocols for Standardization of Clinical Decisions Ann Intern Med, March 7, 2000; 132(5): 373 - 383. [Abstract] [Full Text] [PDF]

				D. Aronsky and P. J. Haug Assessing the Quality of Clinical Data in a Computer-based Record for Calculating the Pneumonia Severity Index J. Am. Med. Inform. Assoc., January 1, 2000; 7(1): 55 - 65. [Abstract] [Full Text] [PDF]

				E. E. Westberg and R. A. Miller The Basis for Using the Internet to Support the Information Needs of Primary Care J. Am. Med. Inform. Assoc., January 1, 1999; 6(1): 6 - 25. [Abstract] [Full Text] [PDF]

				P. F. Brennan Knowing What To Do: International Perspectives on the Roles of Clinical Guidelines and Patient Preferences in Patient Care J. Am. Med. Inform. Assoc., May 1, 1998; 5(3): 317 - 318. [Full Text]