Miller P L, Frawley S J, Sayward F G
Center for Medical Informatics, Yale University School of Medicine, P.O. Box 208009, New Haven, CT 06520-8009, USA.
J Biomed Inform. 2001 Apr;34(2):99-111. doi: 10.1006/jbin.2001.1011.
The paper explores the issues involved in maintaining the logic within a complex computer-based clinical guideline, using as a case study IMM/Serve, an operational guideline whose domain is childhood immunization. For a period of more than a year and a half, we have maintained a log of (1) the national changes to the immunization recommendations, (2) the local customizations of IMM/Serve's logic, and (3) certain logic problems that arose in the process of accommodating these changes and customizations. We describe the nature of these changes, customizations, and problems. We also discuss how different types of domain knowledge might assist in the automated process of validating successive versions of the logic. The paper's goal is to use the immunization domain to provide specific examples of the issues and problems that arise in maintaining a computer-based clinical guideline.
本文探讨了在基于计算机的复杂临床指南中维持逻辑所涉及的问题，以IMM/Serve作为案例研究，IMM/Serve是一个针对儿童免疫接种领域的操作指南。在一年半多的时间里，我们记录了以下内容：（1）国家免疫接种建议的变化；（2）IMM/Serve逻辑的本地定制；（3）在适应这些变化和定制过程中出现的某些逻辑问题。我们描述了这些变化、定制和问题的性质。我们还讨论了不同类型的领域知识如何有助于在逻辑的连续版本验证自动化过程中发挥作用。本文的目标是利用免疫接种领域提供在维护基于计算机的临床指南时出现的问题和难题的具体示例。
