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Clinical Guidelines Adaptation: Managing Authoring and Versioning Issues

This paper discusses the GLARE (GuideLine Acquisition Representation and Execution) system, a joint project aimed at addressing the complexities of clinical guideline adaptation. The system offers a user-friendly interface for domain-independent guidelines, facilitating syntactic and semantic consistency checks, decision-making support, and temporal constraint management. Key features include tools for acquisition and execution alongside interaction capabilities with Health Information Systems (HIS). The need for local adaptation of resources and software is emphasized, targeting specific medical conditions such as bladder cancer and heart failure.

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Clinical Guidelines Adaptation: Managing Authoring and Versioning Issues

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  1. Paolo Terenziani1, Stefania Montani1, Alessio Bottrighi1, Gianpaolo Molino2, Mauro Torchio21 DI, Univ. Piemonte Orientale, Via Bellini 25/G, Alessandria, Italy {terenz, stefania, alessio}@mfn.unipmn.it2 Lab. Informatica Clinica, Az. Ospedaliera S. G. Battista, C.so Bramante 88, Torino, Italy{mtorchio, gmolino}@molinette.piemonte.it Clinical Guidelines Adaptation: Managing Authoring and Versioning Issues

  2. GLARE (GuideLine Acquisition Representation and Execution) • - Joint project: • Dept. Comp. Sci., Univ. Alessandria (It): P. Terenziani, S.Montani, A.Bottrighi • Dept. Comp. Sci., Univ. Torino (It): L.Anselma,G.Correndo • Az. Osp. S. Giovanni Battista, Torino (It): G.Molino, M.Torchio -Domain independent (e.g., bladder cancer, reflux esophagitis, heart failure) -User-friendly (limited number of primitives)

  3. GLARE (Guideline Representation)

  4. GLARE (main features) • Acquisition Tool • Facilities for syntactic & semantic consistency checking • Temporal constraints • Execution Tool • Facilities for decision making (hypothetical reasoning facility) • Temporal constraints • Interaction with HIS • during acquisition • during execution Testing: bladder cancer, reflux esophagitis, heart failure, ischemic stroke

  5. Guideline Adaptation Adaptation needed for dissemination and use Local resources adaptation [Medinfo 04] Local software environment adaptation [Medinfo 04, CGP 04] Update adaptation “Cultural” adaptation

  6. Update Adaptation Two orthogonal issues: History of the different versions (e.g. to justify physicians’ past decisions) (2) Management of authors (users vs. supervisors) (to model update proposal vs update validation)

  7. Guideline Adaptation (1) management of authors (users vs supervisors); (2) management of the status of any piece of knowledge in the GL (proposed vs. accepted knowledge) (3) management of the history of knowledge (considering proposal vs acceptance times); (4) facilities for selecting the parts of a guideline to be changed/updated; (5) facilities for modifying (part of) a guideline (6) facilities for formulating queries and for visualising the updates.

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