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. 2009 Nov;102(11):464-73.
doi: 10.1258/jrsm.2009.090010.

From practice guidelines to clinical decision support: closing the loop

John Fox  1 , Vivek Patkar, Ioannis Chronakis, Richard Begent
Affiliations

From practice guidelines to clinical decision support: closing the loop

John Fox et al. J R Soc Med. 2009 Nov.
No abstract available

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Figures

Figure 1
Figure 1
(a) a CDS application in breast cancer. A screen showing decision options for the imaging for one case, to be taken after medical history and examination. The system recommends an ultrasound scan but recommends against mammography and against doing nothing. For the decision option ‘do an ultrasound of an affected area’, a supporting argument has been expanded to show the justifying evidence (this is an option available to the clinician for all decisions, options and arguments). Links are provided to the relevant supporting literature, which can be accessed by the user if required (e.g. from PubMed); (b) The system allows the user to reject all the arguments of the same grade or lower and at the same time requests reasons for rejections. Here all arguments deriving from recommendations of grade D or lower are rejected and the system will update the suggestions accordingly. The information is captured and will be available for further processing by the system
Figure 2
Figure 2
Three interaction loops for clinicians using CPGs within CDS services. Loop 1: Guideline publishing and feedback – represents the flow of guidance from the guideline authority to the point of care and back. The top-to-bottom part is similar the traditional development and maintenance of paper guidelines; the bottom-up part represents feedback to the authority about use of the guideline in practice; Loop 2: Organizational adaptation and local feedback – represents organization-specific guidance and feedback. A CDS can be customized to meet organizational requirements and constraints, thereby requiring a distinct feedback and monitoring process; Loop 3: Clinician assessment and record – deviations from guidance, if any, are recorded. Clinician modifications to the argumentation (e.g. rebuttals or additions) are taken into account in the CDS's subsequent advice to the clinician and recorded for later review, for self-audit and/or research
Figure 3
Figure 3
An example of an authoring, editorial, publishing and maintenance process for active decision support and guideline services
See this image and copyright information in PMC

References

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