Integrating electronic guidelines into the diagnostic cycle.

Clinical guidelines have been used for diagnostic and treatment purposes, and lately much of this information has become available in electronic formats. In Norway a medical electronic handbook has been developed [1] to give support for the physician, deciding upon diagnoses and treatment. This electronic handbook is now widely used, but not in a systematic fashion - due to lack of user-friendliness. The lack of integration with EPR systems and, more importantly, the lack of integration with the working process, are additional obstacles. In order to improve the usability of the electronic handbook, we have developed a prototype where the commercially-available handbook is tightly integrated with the EPR system and where the EPR system is based on a problem-based approach. The prototype is focused on providing support to the diagnostic process, treatment planning, documentation and pointers to extended knowledge support. The integration of knowledge support and the EPR system was based on a semantic model representation in the middleware and an XML-based representation of the knowledge content within a SQL database. In addition to clinical guidelines, the ICPC-2[2] codes and their inclusion and exclusion criteria are used to support the diagnostic task.