Computerising a guideline for the management of diabetes

Supporting adaptive clinical treatment processes through recommendations

OBJECTIVES

Efficient clinical treatment processes is considered a key factor of medical quality control. Current IT solutions are far away from this perspective since they typically have difficulty supporting the variances occurring in clinical practices, and providing adequate flexible support of clinical processes.

METHODS

This paper proposes a hybrid approach based on rough set theory and case-based reasoning to allow physicians to rapidly adjust patients' treatment processes to changes of patients' clinical states. In detail, the proposed approach recommends appropriate treatment plans in clinical process execution by adopting a similarity measure to select appropriate clinical treatment plans executed on patients who presented similar features to the current one. Such clinical treatment plans are then applied to suggest which actions to perform next in clinical treatment process execution.

RESULTS

As a motivating scenario, this study performs the experiments of type 2 diabetes patient's treatment process. The results show that the proposed approach is feasible to recommend suitable clinical treatment plans in clinical process execution, which makes adaptive clinical treatment processes possible.

Use of a large diabetes electronic medical record system in India: clinical and research applications

BACKGROUND

The diabetes electronic medical record (DEMR) has emerged as an effective information management tool with the potential to improve diabetes care and research. This study reports on the usefulness of the DEMR system at Dr. Mohan's Diabetes Specialities Centre (DMDSC), Chennai, India, for clinical and research purposes.

METHODS

The DEMR, set up in 1996 at DMDSC, connects data of nine centers/clinics in different geographical areas in Southern India. The present data analysis is based on a total of 226,228 patients registered in the DEMR system at DMDSC between the years 1991 and 2010.

RESULTS

The DEMR included data of 139,906 male and 86,322 female patients, of whom 92.6% had type 2 diabetes mellitus (T2DM), 1.4% had type 1 diabetes mellitus (T1DM), and the rest had other types. Patients with T2DM had higher prevalence rates of neuropathy (33.1% vs 13.0%, p < .001), microalbuminuria (25.5% vs 20.0%, p < .001), coronary artery disease (17.5% vs 9.2%, p < .001) and peripheral vascular disease (3.9% vs 2.8%, p = .017) compared with T1DM patients, while prevalence of diabetic retinopathy was similar (37.9% vs 35.7%, p = .06). Prevalence of microvascular and macrovascular complications of diabetes increased with increasing glycated hemoglobin levels (p for trend < .001) and increasing diabetes duration (p for trend < .001).

CONCLUSIONS

The DEMR helps track diabetes care and is a valuable tool for research.

Physicians, guidelines, and cognitive tasks

Using a case study analysis of the Expert Panel Report 3 (EPR-3): Guidelines for the Diagnosis and Treatment of Asthma, this article compares the workflows and knowledge requirements of primary care practice to the structure and content of a well-respected set of clinical guidelines. The authors show that there are discrepancies between physician workflow and the structure of the EPR-3, as well as between physicians' knowledge requirements and the content of the EPR-3. The analysis suggests that closing the gap between medical knowledge and practice will require alternative ways to represent guidelines' knowledge and recommendations.

Computer-based execution of clinical guidelines: a review

PURPOSE

Clinical guidelines are useful tools to standardize and improve health care. The automation of the guideline execution process is a basic step towards its widespread use in medical centres. This paper presents an analysis and a comparison of eight systems that allow the enactment of clinical guidelines in a (semi) automatic fashion.

METHODS

This paper presents a review of the literature (2000-2007) collected from medical databases as well as international conferences in the medical informatics area.

RESULTS

Eight systems containing a guideline execution engine were selected. The language used to represent the guidelines as well as the architecture of these systems were compared. Different aspects have been assessed for each system, such as the integration with external elements or the coordination mechanisms used in the execution of clinical guidelines. Security and terminology issues complement the above study.

CONCLUSIONS

Although these systems could be beneficial for clinicians and patients, it is an ongoing research area, and they are not yet fully implemented and integrated into existing careflow management systems and hence used in daily practice in health care institutions.

Brainstorming about next-generation computer-based documentation: an AMIA clinical working group survey

Computer-based software to record histories, physical exams, and progress or procedure notes, known as computer-based documentation (CBD) software, has been touted as an important addition to the electronic health record. The functionality of CBD systems has remained static over the past 30 years, which may have contributed to the limited adoption of these tools. Early users of this technology, who have tried multiple products, may have insight into important features to be considered in next-generation CBD systems.

OBJECTIVE AND METHODS

We conducted a cross-sectional, observational study of the clinical working group membership of the American Medical Informatics Association (AMIA) to generate a set of features that might improve adoption of next-generation systems. The study was conducted online over a 4-month period; 57% of the working group members completed the survey.

RESULTS

As anticipated, CBD tool use was higher (53%) in this population than in the US physician offices. The most common methods of data entry employed keyboard and mouse, with agreement that these modalities worked well. Many respondents had experience with pre-printed data collection forms before interacting with a CBD system. Respondents noted that CBD improved their ability to document large amounts of information, allowed timely sharing of information, enhanced patient care, and enhanced medical information with other clinicians (all P < 0.001). Respondents also noted some important but absent features in CBD, including the ability to add images, get help, and generate billing information.

CONCLUSIONS

The latest generation of CBD systems is being used successfully by early adopters, who find that these tools confer many advantages over the approaches to documentation that they replaced. These users provide insights that may improve successive generations of CBD tools. Additional surveys of CBD non-users and failed adopters will be necessary to provide other useful insights that can address barriers to the adoption of CBD by less computer literate physicians.