Jacob Jack
Alaska Neonatology/Pediatrix Medical Group, 3340 Providence Dr., Suite 366, Anchorage, AK 99508, USA.
Alaska Med. 2003 Apr-Jun;45(2):41-6.
Embedding clinical guidelines into an electronic medical record is a form of clinical decision support that has the potential to improve the quality and consistency of care provided at the clinical encounter. The manuscript describes the consensus method of developing clinical guidelines and its components that have an impact on its output. These include questions asked, participants, the presentation of information, method of structuring group interaction, and method of synthesizing judgments. Clinicians need to be aware of how these elements can affect guideline development. The quality of research on guideline development is varied. The process of guideline development is poorly documented, not evidence-based, and lacks the transparency that allows users to judge the output and quality of local adherence. The manner in which the presentation of guidelines is structured and implemented is also important in determining adherence. Monitoring guidelines by building a feedback loop is critical for ongoing guideline improvement. The literature on the long-term impact of electronic guidelines on clinician behavior is lacking.
将临床指南嵌入电子病历是一种临床决策支持形式，有可能提高临床诊疗过程中所提供护理的质量和一致性。该手稿描述了制定临床指南的共识方法及其对产出有影响的组成部分。这些包括所提问题、参与者、信息呈现方式、构建小组互动的方法以及综合判断的方法。临床医生需要了解这些要素如何影响指南的制定。关于指南制定的研究质量参差不齐。指南制定过程记录不完善、缺乏循证依据，且缺乏透明度，使得用户难以评判本地遵循情况的产出和质量。指南的呈现结构和实施方式对于确定遵循情况也很重要。通过建立反馈回路来监测指南对于持续改进指南至关重要。关于电子指南对临床医生行为的长期影响的文献尚属空白。
