Abstract
Despite the proliferation of implemented clinical practice guidelines (CPGs) as decision support systems, there is still little evidence of changes in physicians behavior. The reasons usually evoked to explain the low physicians compliance consider the incompleteness of guidelines knowledge, the impreciseness of the terms used and the physicians psychological reluctance. Another reason comes from the original verbal design of CPGs as well as the impossibility to enumerate all the contexts in which a guideline applies, which avoid the automatised control of all CPGs interpretations and therefore the design of robust formal models. The OONCODOC approach proposes a decision support framework for implementing guidelines where the context-based interpretation is controlled by clinicians. The first application deals with breast cancer therapy. Experimented in real size at the point of care, the system demonstrated significantly high scores of theoretical agreement with CPGs recommendations and compliance.
This is a preview of subscription content, log in via an institution to check access.
Preview
Unable to display preview. Download preview PDF.
Similar content being viewed by others
References
Tierney, W. M., Overhage, J. M., Takesue, B. Y., Harris, L. E., Murray, M. D., Vargo, D. L., McDonald, C. J. Computerizing guidelines to improve care and patient outcomes: The example of heart failure. J Am Med Inform Assoc 1995; 2(5): 316–22.
Aliferis, C. F., Miller, R. A. On the heuristic nature of medical decision-support systems. Methods Inf Med 1995; 34(1/2): 4–14.
Bouaud, J., Séroussi, B., Antoine, E.-C., Gozy, M., Khayat, D., Boisvieux, J.-F. Hypertextual navigation operationalizing generic clinical practice guidelines for patient-specific therapeutic decisions. J Am Med Inform Assoc 1998; 5(suppl): 488–92.
Ohno-Machado, L., Gennari, J. H., Murphy, S. H., Jain, N. L., Tu, S. W., Oliver, D. E., Pattison-Gordon, E., Greenes, R. A., Shortlié, E. H., Barnett, G. O. The Guideline Interchange Format: A model for representing guidelines. J Am Med Inform Assoc 1998; 5(4): 357–72.
Fox, J., Johns, N., Rahmanzadeh, A. Disseminating medical knowledge: the PRO-forma approach. Artif Intell Med 1998; 14(1,2): 157–82.
Zielstorff, R. D., Teich, J. M., Paterno, M. D., Segal, M., Kuperman, G. J., Hiltz, F. L., Fox, R. L. P-cape: A high-level tool for entering and processing clinical practice guidelines. J Am Med Inform Assoc 1998; 5(suppl): 478–82.
Shiffman, R. N., Greenes, R. A. Improving clinical guidelines with logic and decision-table techniques: Application to hepatitis imminization recommendations. Med Decis Making 1994; 14: 245–54.
Shahar, Y., Miksch, S., Johnson, P. The Asgaard project: a task-specific framework for the application and critiquing of time-oriented guidelines. Artif Intell Med 1998; 14(1,2): 29–52.
Quaglini, S., Dazzi, L., Gatti, L., Stefanelli, M., Fassino, C., Tondini, C. Supporting tools for guideline development and dissemination. Artif Intell Med 1998; 14(1,2): 119–37.
Lobach, D. F. Electronically distributed, computer-generated, individualized feedback enhances the use of a computerized practice guideline. J Am Med Inform Assoc 1996; 3(suppl): 493–7.
Zielstorff, R. D. Online practice guidelines: Issues, obstacles, and future prospects. J Am Med Inform Assoc 1998; 5(3): 227–36.
Patel, V. L., Allen, V. G., Arocha, J. F., Shortliffe, E. H. Representing clinical guidelines in GLIF: individual and collaborative expertise. J Am Med Inform Assoc 1998; 5(5): 467–83.
Degoulet, P., Fieschi, M., Chatellier, G. Decision support systems from the standpoint of knowledge representation. Methods Inf Med 1995; 34(1/2): 202–8.
Liu, J. C. S., Shiffman, R. N. Operationalization of clinical practice guidelines using fuzzy logic. J Am Med Inform Assoc 1997; 4(suppl): 283–7.
Tierney, W. M., Overhage, J. M., McDonald, C. J. Computerizing guidelines: Factors for success. J Am Med Inform Assoc 1996; 3(suppl): 562–6.
Berger, J. T., Rosner, F. The ethics of practice guidelines. Arch Intern Med 1996; 156: 2051–6.
Advani, A., Lo, K., Shahar, Y. Intention-based critiquing of guideline-oriented medical care. J Am Med Inform Assoc 1998; 5(suppl): 483–7.
Author information
Authors and Affiliations
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 1999 Springer-Verlag Berlin Heidelberg
About this paper
Cite this paper
Séroussi, B., Bouaud, J., Antoine, ÉC. (1999). Enhancing Clinical Practice Guideline Compliance by Involving Physicians in the Decision Process. In: Horn, W., Shahar, Y., Lindberg, G., Andreassen, S., Wyatt, J. (eds) Artificial Intelligence in Medicine. AIMDM 1999. Lecture Notes in Computer Science(), vol 1620. Springer, Berlin, Heidelberg. https://doi.org/10.1007/3-540-48720-4_6
Download citation
DOI: https://doi.org/10.1007/3-540-48720-4_6
Published:
Publisher Name: Springer, Berlin, Heidelberg
Print ISBN: 978-3-540-66162-7
Online ISBN: 978-3-540-48720-3
eBook Packages: Springer Book Archive