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First published November 26, 2002 as JAMIA PrePrint; doi:10.1197/jamia.M1181
Journal of the American Medical Informatics Association 2003;10(2):154-165
© 2003 American Medical Informatics Association

A more recent version of this article appeared on March 1, 2003
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Submitted on July 1, 2002
Accepted on October 28, 2002

Automating Complex Guidelines for Chronic Disease: Lessons Learned

Saverio Maviglia MD, MSc1*, Rita D. Zielstorff RN, MS2, Marilyn Paterno3, Jonathan M. Teich MD, PhD4, David W. Bates MD, MSc1, and Gilad J. Kuperman MD, PhD5

Affiliation of the authors: 1 Partners Healthcare System, Inc., Chestnut Hill, MA, Division of General Internal Medicine, Brigham and Women's Hospital, Boston, MA, Harvard Medical School, Boston, MA; 2 Healthvision, Inc., Waltham, MA; 3 Partners Healthcare System, Inc., Chestnut Hill, MA; 4 Harvard Medical School, Boston, MA, Healthvision, Inc., Waltham, MA, Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA; 5 Partners Healthcare System, Inc., Chestnut Hill, MA, Harvard Medical School, Boston, MA

* To whom correspondence should be addressed.

There is scant published experience with implementing complex, multi-step 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 paper 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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