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 (C) 2008 Elsevier Ireland Ltd. All rights reserved