Technical solutions for integrating clinical practice guidelines with electronic patient records

The success of a decision support system based on clinical practice guidelines does not only depend on the quality of the decision model used to represent and execute guideline recommendations, but also on the design of interactions of the system with the end-user interface and the electronic patient record. This paper describes technical solutions adopted to add decision support functionalities to two existing information systems for stroke patients. Despite the specific medical application, the approach is quite general, relying on two main functionalities: a real-time decision support system based on workflow technology (careflow) and an off-line tool for non-compliance detection, called "Reasoning on Medical Action" (RoMA). The integration has been developed maintaining independence between data management and knowledge management, and minimizing changes to existing user's interfaces. The paper illustrates in particular the middleware layer created to allow communication between the evidence-based system and the electronic patient record.