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Domain-constrained Generation of Clinical Condition Sets to Help Test Computer-based Clinical Guidelines

Affiliation of the author: Yale University School of Medicine, New Haven, Connecticut.

Correspondence and reprints: Perry L. Miller, MD, PhD, Center for Medical Informatics, Yale University School of Medicine, P.O. Box 208009, New Haven, CT 06520-8009; e-mail: <perry.miller{at}yale.edu>.

The paper describes T/Gen, a prototype computer-based tool designed to help maintain the knowledge in a computer-based clinical practice guideline that provides patientspecific recommendations. T/Gen takes as input a set of clinical conditions to which a guideline must react, and allows the user to specify domain-specific constraints as to which combinations of conditions do not make sense or do not need to be exhaustively tested against one another. T/Gen automatically generates constrained sets of combinations of clinical conditions, each corresponding to a clinical case (or to several closely related clinical cases) that can be used to help test the computer-based guideline. The combinations can be used to test the guideline logic using T/Gen's built-in logic interpreter, or to generate a set of test cases for use in testing an operational guideline system. T/Gen has been developed and tested with five pilot guidelines, for two childhood immunization series, for influenza vaccination, for primary thyroid screening, and for embryo transplantation. The paper describes how T/Gen's approach is implemented for the five pilot guidelines, outlines the current status and future directions of the project, and discusses the design issues that arose in the course of carrying out the work.