Computerized assessment with primary care guidelines in The Netherlands

Abstract

To promote quality assurance and expertise in primary health care in the Netherlands the Dutch College of General Practitioners develops protocols, called standards. These standards concern medical action-taking in case of regular complaints and diseases in common practice. To improve dissemination of the standards and to develop effective and useful methods for quality assurance on the basis of the standards a project, called the Guidelines Automation Project (Richtlijnen Automatiseringsproject) was started to develop a computer program that can support quality assurance of medical action-taking in general practice on the basis of the NHG-standards. The main feature of the program is educational assessment. Other features of the program are: guidance for case data collection, stating of differential diagnoses, and disease profiles. These features also use patient case data as a starting point. In conclusion it is argued that all efforts towards an "electronic' use of protocols in the health care delivery system will fail, unless we arrive at a care record that both with respect to its structure and to its content, is being founded on sound formal principles. Several problems need to be solved first. The implementation, and exploitation of protocols, though relatively simple from a knowledge representation point of view, is not a straightforward task.