Miller P L, Frawley S J, Sayward F G
Center for Medical Informatics, Yale University School of Medicine, New Haven, CT, USA.
Proc AMIA Symp. 1998:563-7.
As clinical practice guidelines are increasingly implemented in computer-based form, a major challenge will be to maintain their domain knowledge as new national recommendations are developed and as local customization is required. This maintenance may also need to be performed for any computer-based tools developed to help in the guideline knowledge maintenance process itself. This paper uses the domain of childhood immunization to explore certain issues involved. It describes 1) two recent changes to the national recommendations dealing with the DTP and Polio vaccine series, and 2) several customizations requested by the immunization registries of the State of Oregon and the US Indian Health Service. It then describes how these guideline practice variations are currently handled in three computer-based tools, IMM/Serve, IMM/Def, and IMM/Test. Finally, it discusses how the use of these tools can provide one approach to characterizing the complexity of guideline variations.
随着临床实践指南越来越多地以基于计算机的形式实施，一个主要挑战将是在制定新的国家建议以及需要进行本地定制时，维护其领域知识。对于为协助指南知识维护过程本身而开发的任何基于计算机的工具，可能也需要进行这种维护。本文以儿童免疫领域为例，探讨其中涉及的某些问题。它描述了：1）国家建议中关于百白破疫苗和脊髓灰质炎疫苗系列的两项近期变化；2）俄勒冈州免疫登记处和美国印第安卫生服务局提出的几项定制要求。然后，它描述了目前在三种基于计算机的工具IMM/Serve、IMM/Def和IMM/Test中如何处理这些指南实践差异。最后，它讨论了使用这些工具如何能够提供一种方法来描述指南差异的复杂性。
