BMC Med Inform Decis Mak - Retrospective checking of compliance with practice guidelines for acute stroke care: a novel experiment using openEHR's Guideline Definition Language.

Tópicos

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Resumo

CKGROUND: Providing scalable clinical decision support (CDS) across institutions that use different electronic health record (EHR) systems has been a challenge for medical informatics researchers. The lack of commonly shared EHR models and terminology bindings has been recognised as a major barrier to sharing CDS content among different organisations. The openEHR Guideline Definition Language (GDL) expresses CDS content based on openEHR archetypes and can support any clinical terminologies or natural languages. Our aim was to explore in an experimental setting the practicability of GDL and its underlying archetype formalism. A further aim was to report on the artefacts produced by this new technological approach in this particular experiment. We modelled and automatically executed compliance checking rules from clinical practice guidelines for acute stroke care.METHODS: We extracted rules from the European clinical practice guidelines as well as from treatment contraindications for acute stroke care and represented them using GDL. Then we executed the rules retrospectively on 49 mock patient cases to check the cases' compliance with the guidelines, and manually validated the execution results. We used openEHR archetypes, GDL rules, the openEHR reference information model, reference terminologies and the Data Archetype Definition Language. We utilised the open-sourced GDL Editor for authoring GDL rules, the international archetype repository for reusing archetypes, the open-sourced Ocean Archetype Editor for authoring or modifying archetypes and the CDS Workbench for executing GDL rules on patient data.RESULTS: We successfully represented clinical rules about 14 out of 19 contraindications for thrombolysis and other aspects of acute stroke care with 80 GDL rules. These rules are based on 14 reused international archetypes (one of which was modified), 2 newly created archetypes and 51 terminology bindings (to three terminologies). Our manual compliance checks for 49 mock patients were a complete match versus the automated compliance results.CONCLUSIONS: Shareable guideline knowledge for use in automated retrospective checking of guideline compliance may be achievable using GDL. Whether the same GDL rules can be used for at-the-point-of-care CDS remains unknown.

Resumo Limpo

ckground provid scalabl clinic decis support cds across institut use differ electron health record ehr system challeng medic informat research lack common share ehr model terminolog bind recognis major barrier share cds content among differ organis openehr guidelin definit languag gdl express cds content base openehr archetyp can support clinic terminolog natur languag aim explor experiment set practic gdl under archetyp formal aim report artefact produc new technolog approach particular experi model automat execut complianc check rule clinic practic guidelin acut stroke caremethod extract rule european clinic practic guidelin well treatment contraind acut stroke care repres use gdl execut rule retrospect mock patient case check case complianc guidelin manual valid execut result use openehr archetyp gdl rule openehr refer inform model refer terminolog data archetyp definit languag utilis opensourc gdl editor author gdl rule intern archetyp repositori reus archetyp opensourc ocean archetyp editor author modifi archetyp cds workbench execut gdl rule patient dataresult success repres clinic rule contraind thrombolysi aspect acut stroke care gdl rule rule base reus intern archetyp one modifi newli creat archetyp terminolog bind three terminolog manual complianc check mock patient complet match versus autom complianc resultsconclus shareabl guidelin knowledg use autom retrospect check guidelin complianc may achiev use gdl whether gdl rule can use atthepointofcar cds remain unknown

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