The SAGE (Standards-Based Active Guideline Environment) project was formed to create a methodology and infrastructure required to demonstrate integration of decision-support technology for guideline-based care in commercial clinical information systems. This paper describes the development and innovative features of the SAGE Guideline Model and reports our experience encoding four guidelines. Innovations include methods for integrating guideline-based decision support with clinical workflow and employment of enterprise order sets. Using SAGE, a clinician informatician can encode computable guideline content as recommendation sets using only standard terminologies and standards-based patient information models. The SAGE Model supports encoding large portions of guideline knowledge as re-usable declarative evidence statements and supports querying external knowledge sources.

Clinical practice guidelines have begun to appear in electronic form with the expectation that they will be used to provide automated clinical decision support. Systems capable of executing these clinical practice guidelines are emerging concurrently. A few research projects have developed guideline authoring tools that allow encoding electronic clinical practice guidelines. However, we are not aware of tools that allow testing of electronic clinical practice guidelines by their authors. We have developed a tool called SAGEDesktop for the testing of electronic clinical practice guidelines. SAGEDesktop does not require external infrastructure to carry out this testing. It includes: 1) an embedded guideline engine which can execute electronic clinical practice guidelines 2) functionality that emulates the capabilities of a clinical information system necessary for the execution of the guideline, and 3) terminology server functionality that encapsulates standard clinical terms. Coupled with an authoring tool, SAGEDesktop provides a complete development environment in which precise and robust electronic clinical practice guidelines can be encoded and tested. We describe the features of SAGEDesktop, narrate our vision of the tool's use, and discuss SAGEDesktop's strengths and weaknesses.