Boussadi A, Bousquet C, Sabatier B, Caruba T, Durieux P, Degoulet P
Université Paris Descartes (Paris 5), Paris, France.
Methods Inf Med. 2011;50(1):36-50. doi: 10.3414/ME09-01-0074. Epub 2010 Oct 20.
Several alert systems have been developed to improve the patient safety aspects of clinical information systems (CIS). Most studies have focused on the evaluation of these systems, with little information provided about the methodology leading to system implementation. We propose here an 'agile' business rule design framework (BRDF) supporting both the design of alerts for the validation of drug prescriptions and the incorporation of the end user into the design process.
We analyzed the unified process (UP) design life cycle and defined the activities, subactivities, actors and UML artifacts that could be used to enhance the agility of the proposed framework. We then applied the proposed framework to two different sets of data in the context of the Georges Pompidou University Hospital (HEGP) CIS.
We introduced two new subactivities into UP: business rule specification and business rule instantiation activity. The pharmacist made an effective contribution to five of the eight BRDF design activities. Validation of the two new subactivities was effected in the context of drug dosage adaption to the patients' clinical and biological contexts. Pilot experiment shows that business rules modeled with BRDF and implemented as an alert system triggered an alert for 5824 of the 71,413 prescriptions considered (8.16%).
A business rule design framework approach meets one of the strategic objectives for decision support design by taking into account three important criteria posing a particular challenge to system designers: 1) business processes, 2) knowledge modeling of the context of application, and 3) the agility of the various design steps.
已开发出多种警报系统，以改善临床信息系统（CIS）的患者安全状况。大多数研究都集中在对这些系统的评估上，而关于系统实施方法的信息却很少。我们在此提出一种“敏捷”业务规则设计框架（BRDF），该框架既支持用于验证药物处方的警报设计，又支持将最终用户纳入设计过程。
我们分析了统一过程（UP）设计生命周期，并定义了可用于提高所提议框架敏捷性的活动、子活动、参与者和UML工件。然后，我们将所提议的框架应用于乔治·蓬皮杜大学医院（HEGP）CIS背景下的两组不同数据。
我们在UP中引入了两个新的子活动：业务规则规范和业务规则实例化活动。药剂师对八项BRDF设计活动中的五项做出了有效贡献。在根据患者的临床和生物学情况调整药物剂量的背景下，对这两个新子活动进行了验证。试点实验表明，用BRDF建模并作为警报系统实施的业务规则在71413份处方中的5824份（8.16%）触发了警报。
业务规则设计框架方法通过考虑对系统设计者构成特殊挑战的三个重要标准，满足了决策支持设计的战略目标之一：1）业务流程；2）应用背景的知识建模；3）各个设计步骤的敏捷性。
