Maviglia Saverio M, Zielstorff Rita D, Paterno Marilyn, Teich Jonathan M, Bates David W, Kuperman Gilad J
Partners Healthcare System, Inc., 93 Worcester Street, PO Box 81905, Wellesley, MA 02481, USA.
J Am Med Inform Assoc. 2003 Mar-Apr;10(2):154-65. doi: 10.1197/jamia.m1181.
There is scant published experience with implementing complex, multistep computerized practice guidelines for the long-term management of chronic diseases. We have implemented a system for creating, maintaining, and navigating computer-based clinical algorithms integrated with our electronic medical record. This article describes our progress and reports on lessons learned that might guide future work in this field. We discuss issues and obstacles related to choosing and adapting a guideline for electronic implementation, representing and executing the guideline as a computerized algorithm, and integrating it into the clinical workflow of outpatient care. Although obstacles were encountered at each of these steps, the most difficult were related to workflow integration.
在实施用于慢性病长期管理的复杂、多步骤计算机化实践指南方面，已发表的经验很少。我们已经实施了一个系统，用于创建、维护和浏览与电子病历集成的基于计算机的临床算法。本文描述了我们的进展，并报告了可能指导该领域未来工作的经验教训。我们讨论了与选择和调整电子实施指南、将指南表示并执行为计算机化算法以及将其集成到门诊护理临床工作流程相关的问题和障碍。尽管在这些步骤中的每一步都遇到了障碍，但最困难的与工作流程集成有关。
