Shiffman R N
Center for Medical Informatics, Yale School of Medicine, New Haven, Conn. 06510.
Proc Annu Symp Comput Appl Med Care. 1994:797-801.
Successful local implementation of national guideline recommendations requires attention to factors that promote clinician compliance. Design of a computerized system is described that will implement recommendations from a recently published guideline for outpatient management of childhood asthma exacerbations. Logical analysis of the guideline shows that it is incomplete and contains several ambiguities that must be addressed before the guideline can be operationalized. Once the user-audience is defined guideline decision points are examined and a structured data entry system is devised. Support of clinicians' workflow is provided by an integrated capability for encounter documentation, dosage calculation, and prescription-writing. A pen-based, graphical interface represents an appropriate platform for implementation of the system because of its ease of use and portability.
国家指南建议在地方上的成功实施需要关注促进临床医生依从性的因素。本文描述了一个计算机化系统的设计，该系统将实施最近发布的儿童哮喘急性发作门诊管理指南中的建议。对该指南的逻辑分析表明，它并不完整，包含一些模糊之处，在该指南可实施之前必须加以解决。一旦确定了用户群体，就要检查指南决策点，并设计一个结构化的数据录入系统。通过具备会诊记录、剂量计算和处方书写的综合功能，为临床医生的工作流程提供支持。基于笔的图形界面因其易用性和便携性，是实施该系统的合适平台。
