Standards for Scalable Clinical Decision Support: Need, Current and Emerging Standards, Gaps, and Proposal for Progress

Despite their potential to significantly improve health care, advanced clinical decision support (CDS) capabilities are not widely available in the clinical setting. An important reason for this limited availability of CDS capabilities is the application-specific and institution-specific nature of most current CDS implementations. Thus, a critical need for enabling CDS capabilities on a much larger scale is the development and adoption of standards that enable current and emerging CDS resources to be more effectively leveraged across multiple applications and care settings. Standards required for such effective scaling of CDS include (i) standard terminologies and information models to represent and communicate about health care data; (ii) standard approaches to representing clinical knowledge in both human-readable and machine-executable formats; and (iii) standard approaches for leveraging these knowledge resources to provide CDS capabilities across various applications and care settings. A number of standards do exist or are under development to meet these needs. However, many gaps and challenges remain, including the excessive complexity of many standards; the limited availability of easily accessible knowledge resources implemented using standard approaches; and the lack of tooling and other practical resources to enable the efficient adoption of existing standards. Thus, the future development and widespread adoption of current CDS standards will depend critically on the availability of tooling, knowledge bases, and other resources that make the adoption of CDS standards not only the right approach to take, but the cost-effective path to follow given the alternative of using a traditional, ad hoc approach to implementing CDS

Web-serving Health With St-guide

ST-Guide is a computer-interpretable clinical guidelines development, verification, and implementation project focused on primary care to chronic disease patients. It can be used to implement guides in different modes: authoritarian, apprentice, specialist, and auditor. Only specialist and authoritarian modes are functional in this release. This paper presents the project's web services module, which complies to WSDL and SOAP open standards. ST-Guide's web services architecture allows external computer systems to implement guidelines independently of its underlying operating system and programming language. The kind of technology presented in this paper is considered fundamental to widespread highest standard medical knowledge. ©2008 IEEE.288292Alencar Jr., C., Assistência pré-natal (2001) Projeto Diretrizes, Federação Brasileira das Sociedades de Ginecologia e Ob-stetricia, Associação Médica Brasileira e Conselho Federal de MedicinaBilla, C., Diferentes modos de interacţão num sistema au-tomático de condutas clínicas para o atendimento primário (2004) Dissertaçáo de Mestrado, IC-UnicampBilla, C., Wainer, J., Modo auditor num sistema au-tomático de condutas clínicas para o atendimento primário (2004) CBIS - Congresso Brasileiro de Informática em SaúdeBooch, G., Rumbaugh, J., Jacobson, I., (1998) The unified modeling language user guide, , Addison Wesley, First Edition October 20Bray, T., Paoli, J., Sperberg-McQueen, C., Extensible markup language (XML) 1.0, , http://www.w3.org/TR/REC-xml, Available at, 1998Curbera, F., Duftler, M., Khalaf, R., Nagy, W., Mukhi, N., Weerawarana, S., Unraveling the web services web: An introduction to soap, wsdl, and uddi (2002) Internet Computing, IEEE, 6 (2), pp. 86-93N. G. Development, R. U. in collaboration with British Hypertension Society, and the National Collaborating Centre for Chronic Conditions. Hypertension: management of hypertension in adults in primary care. NICE clinical guideline, 34, 2006Fox, J., Johns, N., Rahmansadeh, A., Disseminating medical knowledge: The proforma approach (1998) Artificial Intelligence in Medicine, 14 (1-2), pp. 157-181Grimshaw, J., Russell, I., Effect of clinical guidelines on medical practice: A systematic review of rigorous evaluations (1993) Lancet, 342 (8883), pp. 1317-1322Joubert, M., Dufour, J., Falco, L., Aymar, S., Fieschi, M., Towards interoperability of heterogeneous health databases: Application to a tumor samples bank (2004) Medinfo, 2004 (11), pp. 1251-1255I. of Medicine. From development to use. Washington D.C., National Academy Press, 1992A. A. of Pediatrics, P. C. for Quality Improvement, and S. on Hyperbilirubinemia. Practice parameter: Management of hyperbilirubinemia in the healthy term newborn. Pediatrics, 94(4):558-565, 1994Peleg, M., Steele, R., Thomson, R., Patkar, V., Rose, T., Fox, J., Open-source publishing of medical knowledge for creation of computer- interpretable guidelines (2005) AJME, pp. 156-160Ruzicka, M., Svatek, V., Mark-up based analysis of narrative guidelines with the stepper tool (2004) Symposium on Computerized Guidelines and Protocols, 101, pp. 132-136Siegel, J., (1996) Corba Fundamentals and Programming, , John Wiley & Sons Inc ComputersVan Rijsbergen, C., (1979) Information Retrieval, , Butterworth-Heinemann, LondonJ. Wainer, C. Billa, M. Dantas, A. Monteiro, and D. Sigulem. St-guide: A framework for the implementation of automatic clinical guidelines. ACM SAC, accepted in 10/19/2007, 2008Wainer, J., Monteiro, A., Anção, M., Sigulem, D., St-guide: A state/transition representation model for clinical guidelines (2002) Technical report, IC-Unicam