Guideline Development & Implementation - XML-Based Tools

一个长期存在的信息学挑战是开发有效的机制，使有效的医疗 诸如实践准则中所载知识可以在支持以下方面的系统中运作 临床医生的决策。然而，实现这一目标的一个令人沮丧的障碍是 难以将指南知识转换为可计算的格式。在此竞争对手的续订申请中 我们提出了一项研究计划，将扩大成功的成果。 1.认识到模糊和模棱两可的建议阻碍了准则的执行和 坚持，我们将模型化和特征的形式的歧义和模糊是普遍存在的 指南声明，确定这些声明导致临床不确定性的程度，并确定 减少这种不确定性的方法。 2.与美国儿科学会和美国家庭学会合作 医生，我们将开发、安装和评估支持高效创作的软件工具 科学有效和可实施的指导方针。与国家专业协会合作提供了一个 有机会将上一次赠款期间开发的工具和技术转移到现实世界中， 将对它们进行评估并反复改进。 3.我们将通过开发工具来帮助翻译自然语言，从而促进指南知识的实施 将建议语言转化为正式规则，并应用基于动作类型的框架进行设计 可在国家和地方两级使用的可重复使用的执行战略。 4.我们将修改并进一步扩展指导原则元素模型，以适应以下概念 对指南文档建模、创作和实施活动至关重要。我们将创建一个XML 模式，并向当前用户提供能力，以确保他们的GEM文件保持兼容。此外， 我们将向HL7和/或ASTM提交新模型作为建议标准。 将指导方针知识转化为运营决策支持系统的系统过程可以 对提供高质量、循证的医疗保健有实质性的好处。此外，建议的 活动的重点是优先影响儿童的系统，儿童是特别脆弱的群体。

A longstanding informatics challenge has been to develop efficient mechanisms whereby valid medical knowledge¿such as that contained in practice guidelines¿can be operationalized in systems that support decision making by clinicians. However, a frustrating impediment to the satisfaction of this goal has been the difficulty of translation of guideline knowledge into computable formats. In this competing renewal application we propose a research program that will extend successful accomplishments. 1. Recognizing that vague and ambiguous recommendations impede both guideline implementation and adherence, we will model and characterize the forms of ambiguity and vagueness that are prevalent in guideline statements, ascertain the degree to which such statements lead to clinical uncertainty, and identify methods to diminish this uncertainty. 2. In collaboration with the American Academy of Pediatrics and the American Academy of Family Physicians, we will develop, install, and evaluate software tools that support efficient authoring of scientifically valid and implementable guidelines. Working with the national professional societies offers an opportunity to move the tools and techniques developed in the last grant period into the real world where they will be evaluated and iteratively improved. 3. We will facilitate implementation of guideline knowledge by developing tools to help translate natural language recommendations into formal rules and apply a framework based on action-types to design reusable implementation strategies that can be used at national and local levels. 4. We will modify and further extend the Guideline Elements Model to accommodate concepts that are critical for guideline document modeling, authoring, and implementation activities. We will create an XML Schema and provide capabilities to current users to assure their GEM files remain compatible. Furthermore, we will submit the new model as a proposed standard to HL7 and/or ASTM. A systematic process for translating guideline knowledge into operational decision support systems can have substantial benefits for delivery of high-quality, evidence based health care. In addition, the proposed activities focus on systems that will preferentially impact children¿a particularly vulnerable population.