Design and implementation of a framework to support the development of clinical guidelines

Clercq, P.A. de; Hasman, Arie; Blom, J. A.; Korsten, H.H.M.

doi:10.1016/s1386-5056(01)00189-7

Cited by 81 publications

(26 citation statements)

References 22 publications

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“…The CDSS Gaston is linked to our EHR, which allows the electronic data stored in the EHR to be used in clinical rules 24 25. The CDSS consists of two modules: (1) a guideline editor for development of electronic guidelines; and (2) a guideline execution engine.…”

Section: Methodsmentioning

confidence: 99%

Strategy for development and pre-implementation validation of effective clinical decision support

et al. 2013

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Objective Well-designed clinical decision support systems (CDSS) can reduce the problem of alert fatigue by generating patient-specific alerts. This paper describes a strategy for the development and pre-implementation validation of specific and relevant clinical rules in order to reduce alert fatigue. Methods A four-step development and validation strategy of clinical rules is presented. As an example, from March to September 2006 the ‘lithium therapy rule’ was developed with this strategy based on the Plan-Do-Check-Act cycle. 15 368 patients were retrospectively screened and 2503 patients were prospectively screened while the positive and negative predictive values (PPV/NPV) were continuously monitored. The first step is to confirm that the parameters used in the definitions are linked to the correct data in the electronic health record; the second step involves an expert team in the review process to assure that alerts generated are clinically relevant; in the third step the rule is adjusted to generate the right alerts in daily practice; and the fourth step ensures technical and therapeutic maintenance after implementation in practice. Results From September 2006 to July 2010 nine other rules were developed following exactly the same strategy. The 10 clinical rules developed showed a progression during the development and all resulted in a final therapeutic PPV of ≥89% before implementation, based on expert opinion. NPV was determined for five clinical rules and was always 100%. Conclusions The proposed strategy is effective for creating specific and reliable clinical rules that generate relevant recommendations. The inclusion of an expert team in the development process is an essential success factor. It is hoped that it will accelerate the widespread use of these promising decision support systems in practice.

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Section: Methodsmentioning

confidence: 99%

Strategy for development and pre-implementation validation of effective clinical decision support

et al. 2013

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“…The EPR and information management functionalities were developed in Microsoft's .NET framework with an SQL server database that is accessible to multiple CARDSS clients within the same clinic. The structured dialogue and decision support modules were developed in GASTON (De Clercq et al, 2001). The system facilitates a genuine multidisciplinary needs assessment, where different clinical users can start, interrupt, and continue the structured dialogue at any time.…”

Section: Development Of the Cardss Systemmentioning

confidence: 99%

Guideline-Based Decision Support Systems for Prevention and Management of Chronic Diseases

Peek¹

2011

Efficient Decision Support Systems - Practice and Challenges in Biomedical Related Domain

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“…18 It is believed that prescription of medicines based on clinical guidelines could limit the use of medicines and result in a decreased expenditure. 19,20 In addition, promotion to use essential medicines (EMs) and generic drugs has been accepted for cost containment. 21 -26 Although there are several methods proposed, each country has to apply them correspondingly to its own health context.…”

Section: Original Articlementioning

confidence: 99%

Response of a Government Hospital to Prescription Cost Savings through its Hospital Formulary in Thailand

Burapadaja¹,

Chinawong²

2010

Journal of Generic Medicines

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It is in doubt about whether response of government hospitals to prescription cost savings can be evaluated through hospital formularies. The objective was to determine a measure refl ecting such response and methods to increase it. An observation on products in a government hospital formulary included their numbers; prices; classes; category, essential medicine (EM) or non-EM; EM sub-lists, List A (basic) to List E; type, generic or brand; and hospital availability, single or dual. The numbers and prices of products were associated with the topics observed. A dominant character of EMs was to increase the numbers, but that of generics was to decrease the prices of products. Single availability expanded the prices of generic and brand products but dual availability narrowed them. For generic products, the numbers decreased but the prices increased from basic to upper EM sub-lists. A hospital formulary could refl ect trend of prescription and cost, therefore it is clear that response to prescription cost savings could be determined through it. Proportion of products that are both EM and generic has been considered as measures indicating such response. Including more EMs and generics and delisting unnecessary brands in the basic EM sub-list and major classes could enhance the response.

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Design and implementation of a framework to support the development of clinical guidelines

Cited by 81 publications

References 22 publications

Strategy for development and pre-implementation validation of effective clinical decision support

Strategy for development and pre-implementation validation of effective clinical decision support

Guideline-Based Decision Support Systems for Prevention and Management of Chronic Diseases

Response of a Government Hospital to Prescription Cost Savings through its Hospital Formulary in Thailand

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