| Abstract |
OBJECTIVE: To elucidate the types of problems
encountered during implementation of a World Wide
Web-based clinical practice guideline to manage
hyperbilirubinemia in newborn infants. DESIGN:
Formative assessment of an automated
clinical-practice guideline in a large-scale
implementation. SETTING: Primary-care clinics and
offices, inpatient clinics, and emergency department
affiliated with an academic children's hospital.
PARTICIPANTS: General pediatricians,
neonatologists, pediatric nurses, and computer
scientists. RESULTS: Existing guidelines for
hyperbilirubinemia management could not be
translated directly into web pages. Modifications of the
original guidelines were required to represent the
clinical intent of the guidelines accurately. In addition,
the automated guideline was augmented to incorporate
a mechanism for generating clinical encounter forms in
order for the system to be accepted into the clinical
work flow. Other clinical considerations that influenced
the final form of the automated guideline included
limitations of computer resources and time constraints
during patient encounters. CONCLUSIONS: Many
existing guidelines are not amenable to straightforward
implementation in automated systems. Strategies to
increase the efficacy of the automated guidelines
included guideline modifications, as well as careful
consideration of the flow of clinical work. Repeated
cycles of development and pilot testing are needed to
design methods to accommodate the constraints
imposed by clinical use. |