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Lamy JB, Ebrahiminia V, Riou C, Seroussi B, Bouaud J, Simon C, Dubois S, Butti A, Simon G, Favre M, Falcoff H, Venot A. How to translate therapeutic recommendations in clinical practice guidelines into rules for critiquing physician prescriptions? Methods and application to five guidelines. BMC Med Inform Decis Mak 2010; 10:31. [PMID: 20509903 PMCID: PMC2893080 DOI: 10.1186/1472-6947-10-31] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2009] [Accepted: 05/28/2010] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Clinical practice guidelines give recommendations about what to do in various medical situations, including therapeutical recommendations for drug prescription. An effective way to computerize these recommendations is to design critiquing decision support systems, i.e. systems that criticize the physician's prescription when it does not conform to the guidelines. These systems are commonly based on a list of "if conditions then criticism" rules. However, writing these rules from the guidelines is not a trivial task. The objective of this article is to propose methods that (1) simplify the implementation of guidelines' therapeutical recommendations in critiquing systems by automatically translating structured therapeutical recommendations into a list of "if conditions then criticize" rules, and (2) can generate an appropriate textual label to explain to the physician why his/her prescription is not recommended. METHODS We worked on the therapeutic recommendations in five clinical practice guidelines concerning chronic diseases related to the management of cardiovascular risk. We evaluated the system using a test base of more than 2000 cases. RESULTS Algorithms for automatically translating therapeutical recommendations into "if conditions then criticize" rules are presented. Eight generic recommendations are also proposed; they are guideline-independent, and can be used as default behaviour for handling various situations that are usually implicit in the guidelines, such as decreasing the dose of a poorly tolerated drug. Finally, we provide models and methods for generating a human-readable textual critique. The system was successfully evaluated on the test base. CONCLUSION We show that it is possible to criticize physicians' prescriptions starting from a structured clinical guideline, and to provide clear explanations. We are now planning a randomized clinical trial to evaluate the impact of the system on practices.
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Affiliation(s)
- Jean-Baptiste Lamy
- Laboratoire d'Informatique Médicale et de Bioinformatique (LIM&BIO), UFR SMBH, University of Paris 13, 74 rue Marcel Cachin, 93017 Bobigny cedex, France
| | - Vahid Ebrahiminia
- Université Paris 12, UFR de Médecine, Créteil, France; AP-HP, Hôpital Henri Mondor, Département d'Information Hospitalier, Créteil, France
| | - Christine Riou
- U936 INSERM, University of Rennes 1, IFR 140, Rennes, France
| | - Brigitte Seroussi
- Laboratoire d'Informatique Médicale et de Bioinformatique (LIM&BIO), UFR SMBH, University of Paris 13, 74 rue Marcel Cachin, 93017 Bobigny cedex, France
- Université Paris 6, UFR de Médecine, Paris, France; AP-HP, Hôpital Tenon, Département de Santé Publique, Paris, France
| | - Jacques Bouaud
- AP-HP, DSI, STIM, Paris, France; INSERM, UMR_S 872, eq. 20, Paris, France
| | - Christian Simon
- Silk Informatique, 40 bis avenue du général Patton, 49000 Angers, France
| | - Stéphane Dubois
- RESIP, Centre Directionnel 56 rue Ferdinand Buisson BP 455, 62206 Boulogne sur Mer Cedex, France
| | - Antoine Butti
- RESIP, Centre Directionnel 56 rue Ferdinand Buisson BP 455, 62206 Boulogne sur Mer Cedex, France
| | - Gérard Simon
- ESIRIM, 39 allée de la Pitancerie F94230 Cachan, France
| | - Madeleine Favre
- Université Paris Descartes, Faculté de Médecine, Département de Médecine Générale, 75015 Paris; Société de Formation Thérapeutique du Généraliste (SFTG), 233 bis rue de Tolbiac, 75013 Paris, France
| | - Hector Falcoff
- Université Paris Descartes, Faculté de Médecine, Département de Médecine Générale, 75015 Paris; Société de Formation Thérapeutique du Généraliste (SFTG), 233 bis rue de Tolbiac, 75013 Paris, France
| | - Alain Venot
- Laboratoire d'Informatique Médicale et de Bioinformatique (LIM&BIO), UFR SMBH, University of Paris 13, 74 rue Marcel Cachin, 93017 Bobigny cedex, France
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Abstract
Innovative technological approaches offer great promise for enhancing the quality of care and improved access. A chronic care model has been shown repeatedly to improve outcomes. The elements of the model include the health system, community, self-management support, decision support, clinical information systems, and delivery system redesign. Understanding opportunities to apply technology to the chronic care model is critically important as the rates of diabetes escalate and quality care becomes a priority for health systems.
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Affiliation(s)
- Linda M Siminerio
- University of Pittsburgh Diabetes Institute, Pittsburgh, Pennsylvania 15203, USA.
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Albisser AM. Technophobia, prescription checking and the future of diabetes management. Diabetologia 2009; 52:1013-8. [PMID: 19357829 DOI: 10.1007/s00125-009-1341-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2009] [Accepted: 02/23/2009] [Indexed: 10/20/2022]
Abstract
Is the medical prescription the root cause of the long-term complications of diabetes mellitus? This article presents the argument for introducing prescription checking into diabetes disease management. It discusses an evidence-based need for frequent revisions of the medical prescription as the key to preventing treatment-related complications in diabetes while achieving the now mandated standards in patient care. To do this it will be prudent for diabetes healthcare providers to enrich their clinical services with new information technology-based tools. These are easily acquired by participating in professional workshops focused on advanced diabetes management. In this light, the case presented here challenges leading practitioners to become early participants in the evolution of information technology that will ultimately enhance the management of all patients with diabetes.
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Affiliation(s)
- A M Albisser
- Diabetes Control and Complications Treatment Initiative, BCMC Better Control Medical Computers, Hollywood, FL 33019, USA.
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Petrasek D, Bidner M. Analysis of the performance of the software/hardware product MyDiaBase+RxChecker for assessing treatment regimens. J Diabetes Sci Technol 2009; 3:533-5. [PMID: 20144292 PMCID: PMC2769880 DOI: 10.1177/193229680900300318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
In 2008, the Action to Control Cardiovascular Risk in Diabetes trial was halted due to an unexpected number of deaths in the intensive treatment group (aiming for hemoglobin A1c levels less than 6%). Hypoglycemic episodes were thought by some to be a contributing cause, underscoring again the challenge of maintaining tight control while avoiding dangerous excursions into hypoglycemic territory. Albisser and colleagues present a set of articles in this issue of Journal of Diabetes Science and Technology that describe a clinical product developed specifically for this timeless clinical conundrum.
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Affiliation(s)
- Danny Petrasek
- California Institute of Technology (Caltech), Los Angeles, CA 90046, USA.
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