A Computer-Interpretable Version of the AACE, AME, ETA Medical Guidelines for Clinical Practice for the Diagnosis and Management of Thyroid Nodules

Peleg, Mor; Fox, John; Patkar, Vivek; Glasspool, David; Chronakis, Ioannis S.; South, Matthew; Nassar, Svetlana; Gaglia, Jason L.; Gharib, Hossein; Papini, Enrico; Paschke, Ralf; Duick, Daniel S.; Valcavi, Roberto; Garber, Jeffrey R.

doi:10.4158/ep13271.or

Cited by 21 publications

(13 citation statements)

References 15 publications

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“…Most previously reported rule-based CDS systems have contained fewer than a dozen decision nodes and required only a small number of data parameters to function [40-42]. …”

Section: Discussionmentioning

confidence: 99%

Increasing Complexity in Rule-Based Clinical Decision Support: The Symptom Assessment and Management Intervention

Df¹,

Eb²,

Halpenny³

et al. 2016

JMIR Med Inform

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BackgroundManagement of uncontrolled symptoms is an important component of quality cancer care. Clinical guidelines are available for optimal symptom management, but are not often integrated into the front lines of care. The use of clinical decision support (CDS) at the point-of-care is an innovative way to incorporate guideline-based symptom management into routine cancer care.ObjectiveThe objective of this study was to develop and evaluate a rule-based CDS system to enable management of multiple symptoms in lung cancer patients at the point-of-care.MethodsThis study was conducted in three phases involving a formative evaluation, a system evaluation, and a contextual evaluation of clinical use. In Phase 1, we conducted iterative usability testing of user interface prototypes with patients and health care providers (HCPs) in two thoracic oncology clinics. In Phase 2, we programmed complex algorithms derived from clinical practice guidelines into a rules engine that used Web services to communicate with the end-user application. Unit testing of algorithms was conducted using a stack-traversal tree-spanning methodology to identify all possible permutations of pathways through each algorithm, to validate accuracy. In Phase 3, we evaluated clinical use of the system among patients and HCPs in the two clinics via observations, structured interviews, and questionnaires.ResultsIn Phase 1, 13 patients and 5 HCPs engaged in two rounds of formative testing, and suggested improvements leading to revisions until overall usability scores met a priori benchmarks. In Phase 2, symptom management algorithms contained between 29 and 1425 decision nodes, resulting in 19 to 3194 unique pathways per algorithm. Unit testing required 240 person-hours, and integration testing required 40 person-hours. In Phase 3, both patients and HCPs found the system usable and acceptable, and offered suggestions for improvements.ConclusionsA rule-based CDS system for complex symptom management was systematically developed and tested. The complexity of the algorithms required extensive development and innovative testing. The Web service-based approach allowed remote access to CDS knowledge, and could enable scaling and sharing of this knowledge to accelerate availability, and reduce duplication of effort. Patients and HCPs found the system to be usable and useful.

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“…Most previously reported rule-based CDS systems have contained fewer than a dozen decision nodes and required only a small number of data parameters to function [40-42]. …”

Section: Discussionmentioning

confidence: 99%

Increasing Complexity in Rule-Based Clinical Decision Support: The Symptom Assessment and Management Intervention

Df¹,

Eb²,

Halpenny³

et al. 2016

JMIR Med Inform

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“…Unlike Arden Syntax, GLIF3 can manage complex guidelines with many care steps. 109 In Peleg et al., 110 web-based interactive clinical algorithms were developed based on this formalism for the sequencing of tasks to analyse patients with particular clinical conditions. We refer readers to Mulyar et al.…”

Section: The Role Of Cigs In Cdss-augmented Delivery Of Carementioning

confidence: 99%

The use of computer-interpretable clinical guidelines to manage care complexities of patients with multimorbid conditions: A review

2018

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Clinical practice guidelines (CPGs) document evidence-based information and recommendations on treatment and management of conditions. CPGs usually focus on management of a single condition; however, in many cases a patient will be at the centre of multiple health conditions (multimorbidity). Multiple CPGs need to be followed in parallel, each managing a separate condition, which often results in instructions that may interact with each other, such as conflicts in medication. Furthermore, the impetus to deliver customised care based on patient-specific information, results in the need to be able to offer guidelines in an integrated manner, identifying and managing their interactions. In recent years, CPGs have been formatted as computer-interpretable guidelines (CIGs). This enables developing CIG-driven clinical decision support systems (CDSSs), which allow the development of IT applications that contribute to the systematic and reliable management of multiple guidelines. This study focuses on understanding the use of CIG-based CDSSs, in order to manage care complexities of patients with multimorbidity. The literature between 2011 and 2017 is reviewed, which covers: (a) the challenges and barriers in the care of multimorbid patients, (b) the role of CIGs in CDSS augmented delivery of care, and (c) the approaches to alleviating care complexities of multimorbid patients. Generating integrated care plans, detecting and resolving adverse interactions between treatments and medications, dealing with temporal constraints in care steps, supporting patient-caregiver shared decision making and maintaining the continuity of care are some of the approaches that are enabled using a CIG-based CDSS.

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“…Computer-interpretable algorithm (96,97) Mobile device (98,99) Patient health records (83)(84)(85)(86)(87) Web-based (100)…”

Section: Electronic Formatsmentioning

confidence: 99%

American Association of Clinical Endocrinologists and American College of Endocrinology Protocol for Standardized Production of Clinical Practice Guidelines, Algorithms, and Checklists – 2017 Update

Mechanick¹,

Pessah-Pollack²,

Camacho³

et al. 2017

Endocrine Practice

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A Computer-Interpretable Version of the AACE, AME, ETA Medical Guidelines for Clinical Practice for the Diagnosis and Management of Thyroid Nodules

Cited by 21 publications

References 15 publications

Increasing Complexity in Rule-Based Clinical Decision Support: The Symptom Assessment and Management Intervention

Increasing Complexity in Rule-Based Clinical Decision Support: The Symptom Assessment and Management Intervention

The use of computer-interpretable clinical guidelines to manage care complexities of patients with multimorbid conditions: A review

American Association of Clinical Endocrinologists and American College of Endocrinology Protocol for Standardized Production of Clinical Practice Guidelines, Algorithms, and Checklists – 2017 Update

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