Division of Biomedical Informatics, School of Medicine, University of California San Diego, 9500 Gilman Drive #0728, La Jolla, CA 92093-0728, USA.
J Biomed Inform. 2012 Oct;45(5):938-49. doi: 10.1016/j.jbi.2012.03.005. Epub 2012 Mar 29.
RESEARCH PURPOSE: We have designed a prototype clinical workflow system that allows the specification and enactment of medical guidelines in terms of clinical goals to be achieved, maintained or avoided depending on the patient's disease and treatment evolution. The prototype includes: (1) an argumentation-based decision support system which can be used both to represent medical decisions within guidelines, and to dynamically choose the most suitable plans to achieve clinical goals, and (2) mechanisms to specify a health organization's facilities and health workers skills and roles, which can be taken into account during the decision process in order to improve quality of care.
The framework has been fully implemented in the COGENT formal modeling system. The prototype has been evaluated implementing a hypertension guideline.
The framework has shown flexibility and adaptability in (1) advising and tailoring health care based on a health organization's resources and a patient's particular medical condition, (2) delegating health care, and (3) replanning when unexpected situations arise.
研究目的：我们设计了一个临床工作流程原型系统，该系统允许根据要实现、维持或避免的临床目标来规范和执行医疗指南，具体取决于患者的疾病和治疗进展。该原型包括：（1）基于论证的决策支持系统，可用于在指南内表示医疗决策，并动态选择最合适的计划来实现临床目标，以及（2）指定医疗机构的设施和卫生工作者技能和角色的机制，可在决策过程中考虑这些因素，以提高护理质量。
该框架已在 COGENT 形式化建模系统中得到全面实现。该原型已通过实施高血压指南进行了评估。
该框架在以下方面表现出了灵活性和适应性：（1）根据医疗机构的资源和患者的特定医疗状况提供建议和调整医疗服务，（2）委托医疗服务，以及（3）在出现意外情况时重新规划。
