The SAGE Guideline Model: achievements and overview

Abstract

The SAGE (Standards-Based Active Guideline Environment) project was formed to create a methodology and infrastructure required to demonstrate integration of decision-support technology for guideline-based care in commercial clinical information systems. This paper describes the development and innovative features of the SAGE Guideline Model and reports our experience encoding four guidelines. Innovations include methods for integrating guideline-based decision support with clinical workflow and employment of enterprise order sets. Using SAGE, a clinician informatician can encode computable guideline content as recommendation sets using only standard terminologies and standards-based patient information models. The SAGE Model supports encoding large portions of guideline knowledge as re-usable declarative evidence statements and supports querying external knowledge sources.

Figure 1

Terminology hierarchy showing terms defined by the expression CHF ∧ (¬Pleural effusion due to CHF).

Figure 2

SAGE VMR classes and details of the Observation class.

Figure 3

Alternative representations of Supine Systolic Blood Pressure.

Figure 4

A SAGE expression template specifying a criterion testing for the presence of congestive heart failure observation during an encounter.

Figure 5

Activity graph specifying SAGE DSS’s response to decision-support opportunities in the clinical workflow.

Figure 6

A SAGE order set shown in the Protégé editor. The order set specifies alternative (OR Boolean connective) drug orders for managing community-acquired pneumonia.

Figure 7

The Medication section of the CAP order set shows checked pre-selection flags and patient-specific annotations.